Video 1
During 2-dimensional transesophageal echocardiography (TEE), a mass was observed in the right atrium and later identified as a large mass measuring 7 × 3.0 cm, with the body measuring 3.5 × 3.0 cm and the stalk measuring 3.5 × 1.0 cm; it originated in the superior vena cava and occupied significant space in the right atrium. Intraoperatively, attempts were made to extract the mass using the AngioVac cannula, but its size and chronicity posed challenges despite multiple high-flow suction attempts. Subsequently, the FlowTriever 2 was utilized alongside active suction from the AngioVac to break up the mass while efforts were made to extract it. A mesh disc was employed to prevent embolization during the procedure. Although the main body of the mass was successfully extracted, a sizable peduncle/stalk remained attached to the superior vena cava, necessitating the use of a snare to cut the base of the mass. Ultimately, the mass, along with its stalk, was completely extracted through the AngioVac, resulting in the resolution of the mass with no residual fragments remaining; see also at https://youtu.be/0fA2d-mKOK0.
Figure 1
A cine showing the use of the two devices: (A) Inari FlowTriever sheath in the right internal jugular vein and the AngioVac from the femoral approach. (B) FlowTriever 2 disc. (C) FlowTriever catheter’s nitinol mesh disc to prevent clot migration, while the AngioVac catheter is being removed with a mass attached.
Figure 2
The gross appearance of the mass after successful fragmentation and extraction.