https://doi.org/10.1177/0267659120946734 Perfusion 1–5 © The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0267659120946734 journals.sagepub.com/home/prf Introduction Thrombi in the vena cava and in the right atrium (RA) present a risk factor for increased morbidity and mortal- ity, and are associated with the potential risk of pulmo- nary embolism (PE). 1 Foreign bodies such as previously placed cardiac leads may cause thrombotic material to form. 2 The removal of thrombi or lead vegetations from the above mentioned sites is commonly associated with open heart surgery including sternotomy and the use of a heart–lung machine (HLM). In contrast, percutaneous aspiration of thrombi or vegetations using the AngioVac system is a minimally invasive method that does not require a sternotomy, thus resulting in less surgical trauma. However, the equipment of the extracorporeal circuit to perform this minimally invasive procedure safely has not yet been described in detail. Material and methods A closed circuit was designed where the suction gener- ated by the rotation of a centrifugal pump (Revolution 5, LivaNova, Mirandola, Italy) is used to aspirate the solid material in a bubble trap (CAPIOX BT15, Terumo, Ann Arbor, MI, USA) that is situated before the inlet of the centrifugal pump (see Figure 1 and 4). This bubble trap incorporates a 170-µm filter wrought from polyester which is capable of separating solid material from the bloodstream and retaining bubbles. All circuit lines Technical implementation of percutaneous thrombus aspiration using the AngioVac system Benjamin Haupt, 1,2 Frank Merkle, 2,3 Thomas Dreizler, 1 Volkmar Falk 4,5,6 and Christoph Starck 3,4,5 Abstract Objectives: The AngioVac system (AngioDynamics, Latham, NY, USA) provides a method for the minimally invasive, percutaneous aspiration of thrombus formations originating from the central venous system as well as solid matter such as lead vegetations and right atrial thrombi. Methods: This retrospective, observational study describes the initial experience in 52 adult patients with the AngioVac system, focusing mainly on the development of the extracorporeal circuit to improve usability and safety. Results: The mean patient age was 62.9 years (range 23-86 years). 22 patients were female and 30 were male. Indications for percutaneous aspiration were lead vegetations (n = 36; 69.2%), right atrial thrombi (n = 9; 17.3%), central venous thrombi (n = 5; 9.6%) and pulmonary embolisms (n = 2; 3.8%). Successful aspiration was performed in 44 cases (84.6%) and partial success was achieved in five patients (9.6%), while failure to remove thrombi or vegetations occurred in three cases (5.8%). Our practical experience led to the installation of a shunt line for recirculation and the implementation of safety features concerning air handling, which are also employed in minimally invasive extracorporeal bypass circuits. Initial tests monitored the level of negative pressure according to differences in flow and access sites but these still have to be validated on a larger scale. Conclusion: In this initial experience, the AngioVac system appeared to be safe regarding the extracorporeal circulation and the elimination of thrombi and lead vegetations. Keywords vacuum-assisted thrombectomy; AngioVac system; pacemaker lead thrombosis; pulmonary embolism 1 Department of Perfusion, German Heart Center Berlin, Berlin, Germany 2 Academy for Perfusion, German Heart Center Berlin, Berlin, Germany 3 Steinbeis-Transfer-Institut Kardiotechnik, Steinbeis-Hochschule Berlin, Berlin, Germany 4 Department of Cardiovascular Surgery, German Heart Center Berlin, Berlin, Germany 5 DZHK (German Center for Cardiovascular Research), Berlin, Germany 6 Department of Cardiothoracic Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany Corresponding author: Benjamin Haupt, Academy for Perfusion, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Email: haupt@dhzb.de 946734PRF 0 0 10.1177/0267659120946734PerfusionHaupt et al. research-article 2020 Practical Technique