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Marcus D'Ayala, MD, (left) and Berhane Worku, MD, (center) perform a procedure to remove a large clot from a patient's heart.

It is estimated that nearly 100,000 Americans die from blood clots each year. These clots usually fall into one of two categories-thrombi, which form locally in the blood vessels; and emboli, which form in other areas of the body's circulatory system, break off, and are carried via the blood stream until they become lodged in a blood vessel. Thanks to a new catheterization system being used at New York Methodist Hospital (NYM), surgeons can literally vacuum up entire blood clots and filter them out of the body's blood supply.

"This is a life-saving system," said Anthony Tortolani, MD, chairman of surgery and cardiothoracic surgery at NYM. "There are maybe as many as 20 cases per year in Brooklyn in which patients die from pulmonary emboli (blood clots in the lungs) and we will now be able to save their lives, thanks to the new procedure, and the expertise of our surgical team."

The benefits of the system (called "AngioVac") are particularly important in high-risk cases where large clots obstruct blood flow in a patient's lungs, or in which a clot protrudes into the heart from the surrounding veins.

"This is a percutaneous (needle-entry via the skin) system, requiring no incisions," said Berhane Worku, MD, attending cardiothoracic surgeon at NYM. "The 'vacuuming' device is threaded through the veins to the site of the clot. The device is connected to a standard cardiopulmonary (heart-lung) bypass system that takes the body's blood-along with the clot-and passes it through a large external circuit. As the blood travels through that circuit, a filtering system traps clots before returning the filtered blood to the body. For certain patients with particularly large clots, the ability to filter a whole clot out at once may reduce or eliminate the need for an open surgical procedure that might have carried a considerably higher risk of complication-or been entirely impossible."

"AngioVac requires a multidisciplinary team," says Marcus D'Ayala, MD, chief of vascular surgery at NYM. "In addition to the cardiothoracic surgeon who maneuvers the device, a perfusionist is needed to manage and control the blood flow through the circuit, since it operates via a centrifugal blood pump. If the device is removing a large clot that extends into the heart, a cardiac anesthesiologist will be needed to monitor a live, transesophageal echocardiogram throughout the procedure.

"At NYM, we were fortunate to have the 'expertise infrastructure' that allowed our cardiothoracic and vascular surgeons to train on the AngioVac system and immediately incorporate it into some very high-risk procedures, with excellent results," Dr. D'Ayala continued. "The ability to sift through a patient's entire blood volume with no incision, and filter out large clots in the process, is life-saving, plain and simple.