Percutaneous Mechanical Aspiration Prior to Transvenous Lead Extraction and Implantable Cardioverter Defibrillator Removal in Infective Endocarditis

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Cardiovascular implantable electronic device (CIED) infective endocarditis with large vegetations requires transvenous extraction.¹ However, vegetations greater than 2 cm in length have a high embolization risk and require surgical removal.^1,2

A 59-year-old man with heart failure with reduced ejection fraction (HFrEF) and a single-chamber implantable cardioverter-defibrillator presented with group B streptococcus bacteremia. Transesophageal echocardiography (TEE) revealed a 2.4 x 1.5-cm vegetation on the atrial portion of the right ventricular lead (Figure A and B). Due to the embolization risk with extraction alone, percutaneous mechanical aspiration (PMA) using the AngioVac system (AngioDynamics) was pursued. The AngioVac system, consisting of aspiration cannulas connected to a veno-venous perfusion circuit, was inserted via the right internal jugular vein. Under TEE guidance, the aspiration catheter removed the vegetation (Figure C-F) and then repositioned to capture residual vegetative material. The lead was successfully extracted and pathology confirmed infection (Figure G and H). For CIED vegetations, percutaneous mechanical aspiration followed by extraction may reduce embolization risk.

Faaiq N. Aslam, MD¹; Kevin Tayon, MD² ; Jeanwoo Yoo, DO² ; Abdallah El Sabbagh, MD²; Danesh Kella, MBBS² ; Christoffel J. van Niekerk, MD²

From the Departments of ¹Internal Medicine and ²Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida.

Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.

Consent statement: The authors confirm that informed consent was obtained from the patient(s) for the intervention(s) described in the manuscript and for the publication othereof, including any and all images.

Address for correspondence: Christoffel J. van Niekerk, MD, Mayo Clinic Department of Cardiovascular Disease, 4500 San Pablo Road, Jacksonville, FL 32224, USA. Email: vanniekerk.christoffel@mayo.edu

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