Physicians Remove Dangerous Blood Clot at The Jewish Hospital - Mercy Health in Cincinnati's First AngioVac Procedure

(CINCINNATI; May 6, 2014) – Mercy Health, which provides advanced, compassionate, quality care in your neighborhood through its care network, announces that vascular surgeon Charles Mesh, MD and cardiac surgeon Russell Vester, MD performed Cincinnati’s first AngioVac procedure at The Jewish Hospital – Mercy Health. Together, the surgeons treated a patient with a dangerous blood clot successfully. The AngioVac is a new tool that physicians use to remove large, life-threatening blood clots when traditional methods such as drug therapy or open surgery may take too long or are too risky.

“A routine test found microscopic amounts of blood in our patient’s urine. Imaging revealed a blood clot about the size of a hot dog in the patient’s inferior vena cava. The cava is the largest vein in the body and returns all the blood from the legs and abdomen directly to the heart,” says Dr. Mesh.

“We could see that the clot wasn’t fixed to wall of vena cava. It could potentially cause sudden death by breaking away at any time, traveling to the heart and blocking all blood flow,” says Dr. Vester.

Doctors determined that the patient has a blood clotting disorder that led to the formation of the large clot. Typically, with a free-floating clot, doctors would insert a filter to trap it and keep it from traveling toward the lungs or heart. They would follow this with anticoagulation, or blood thinning, treatment to dissolve the clot.

“This was a challenging case because the clot was so large and it extended to the kidneys. A filter placed above the kidneys can lead to kidney failure so that wasn’t an option for this patient. In the past, we would have opened the patient’s abdomen and vena cava to remove the clot. This is major surgery lasting about three hours that requires a week’s stay in the hospital and ample recovery time,” says Dr. Mesh. “This patient, however, was an ideal candidate for the AngioVac procedure, which is less invasive and allows shorter hospital stays and a quicker recovery.” 

During the AngioVac procedure, the surgical team places a large cannula, or tube, into the patient’s neck vein. This tube runs through the heart and into the vena cava. It attaches to a pump, which draws blood out of the patient at a rate of one to three liters per minute. Blood returns to the patient through another cannula that doctors place in a major vein in the leg. Under X-ray guidance, doctors activate the AngioVac, creating a strong, exterior blood circuit, which draws the clot out.

“Essentially, we established the patient’s blood flow pathway outside his body, injected dye to see where things were, turned on the AngioVac and sucked out blood and the clot. A filter in the circuit caught the clot. Once the tubes were in, the procedure took 15 minutes,” says Dr. Vester, who notes that the patient went home two days after the procedure.

“The procedure requires technical expertise and correct patient selection,” notes Dr. Mesh. “Provided the patient meets the criteria and there’s a trained AngioVac team available, this procedure is a good option for clot removal with additional benefits in reduced length of hospital stay and a shorter recovery time.