Advertisement

Significant vascular complications in percutaneous axillary intra-aortic balloon pump

Published:January 04, 2022DOI:https://doi.org/10.1016/j.avsg.2021.12.078

      Abstract

      Objective

      Axillary Intra-aortic balloon pump (IABP) has been increasingly utilized for hemodynamic support in heart failure patients. Vascular complications associated with axillary IABP such as dissection or rupture are relatively rare but not negligible that could negatively affect clinical outcomes. We summarized our experiences.

      Methods

      This is a retrospective study reviewing of all patients receiving an axillary IABP between June 2016 and November 2020. A total of 199 patients underwent percutaneous axillary IABP placement. 6 patients (6/199, 3.0%) were complicated with arterial/aortic dissection or rupture during the procedures or the course of treatment. We described their clinical presentations and outcomes.

      Results

      Vascular complications included acute type A aortic dissection in 2 patients, descending aortic rupture in 1 patient, abdominal aortic rupture along with type B aortic dissection in 1 patient, and the localized left subclavian artery dissection in 2 patient. 2 type A aortic dissection cases were surgically treated: 1 with emergent left ventricle assist device and ascending aorta replacement, the other with emergent left ventricle assist device. Emergent endovascular treatment was successfully performed in 2 aortic rupture cases. The left subclavian artery dissection cases were managed medically. The postoperative/treatment course was uneventful in all patients.

      Conclusion

      Percutaneous axillary IABP therapy can cause significant vascular complications. Early diagnosis and prompt treatment would be the key to improve the clinical outcomesv.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Annals of Vascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Heidenreich PA, Albert NM, Allen LA, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013;6:606-19.

        • Yancy CW
        • Jessup M
        • Bozkurt B
        • et al.
        2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American heart association task force on practice guidelines.
        J Am Coll Cardiol. 2013; 62: e147-e239
        • Vieira JL
        • Ventura HO
        • Mehra MR.
        Mechanical circulatory support devices in advanced heart failure: 2020 and beyond.
        Prog Cardiovasc Dis. 2020; 63: 630-639
        • Stretch R
        • Sauer CM
        • Yuh DD
        • et al.
        National trends in the utilization of short-term mechanical circulatory support: incidence, outcomes, and cost analysis.
        J Am Coll Cardiol. 2014; 64: 1407-1415
        • Bhimaraj A
        • Agrawal T
        • Duran A
        • et al.
        Percutaneous left axillary artery placement of intra-aortic balloon pump in advanced heart failure patients.
        JACC Heart Fail. 2020; 8: 313-323
        • Nishida H
        • Koda Y
        • Kalantari S
        • et al.
        Outcomes of ambulatory axillary intraaortic balloon pump as a bridge to heart transplantation.
        Ann Thorac Surg. 2020; 111: 1264-1270
        • Frohwein S
        • Ververis JJ
        • Marshall JJ.
        Subclavian artery dissection during diagnostic cardiac catheterization: the role of conservative management.
        Cathet Cardiovasc Diagn. 1995; 34: 313-317
        • Marik PE
        • Mclaughlin MT.
        Spontaneous subclavian artery dissection: a pain in the neck diagnosis.
        BMJ Case Rep. 2013; 21 (bcr2013201223): 2013
        • Nagino N
        • Funakoshi H
        • Shiga T
        • et al.
        Spontaneous subclavian artery dissection causing ischemia of the medulla oblongata and cerebellum.
        J Emerg Med. 2017; 53: e77-e80
        • Onishi H
        • Yamamura O
        • Matsuo S
        • et al.
        Localized right subclavian artery dissection detected by accident on an ultrasound examination: a case report and literature review.
        Intern Med. 2019; 58: 73-78
        • O'Rourke MF
        • Shepherd KM.
        Protection of the aortic arch and subclavian artery during intra-aortic balloon pumping.
        J Thorac Cardiovasc Surg. 1973; 65: 543-546
        • Meco M
        • Gramegna G
        • Yassini A
        • et al.
        Mortality and morbidity from intra-aortic balloon pumps. Risk analysis.
        J Cardiovasc Surg (Torino). 2002; 43: 17-23
        • Beckman CB
        • Geha AS
        • Hammond GL
        • et al.
        Results and complications of intraaortic balloon counterpulsation.
        Ann Thorac Surg. 1977; 24: 550-559
        • Harvey JC
        • Goldstein JE
        • McCabe JC
        • et al.
        Complications of percutaneous intraaortic balloon pumping.
        Circulation. 1981; 64: II114-II117
        • Jacobs LE
        • Fraifeld M
        • Kotler MN
        • et al.
        Aortic dissection following intraaortic balloon insertion: recognition by transesophageal echocardiography.
        Am Heart J. 1992; 124: 536-540
        • Hurwitz LM
        • Goodman PC.
        Intraaortic balloon pump location and aortic dissection.
        AJR Am J Roentgenol. 2005; 184: 1245-1246
        • Trabattoni P
        • Zoli S
        • Dainese L
        • et al.
        Aortic dissection complicating intraaortic balloon pumping: percutaneous management of delayed spinal cord ischemia.
        Ann Thorac Surg. 2009; 88: e60-e62
        • de Agustin JA
        • de Diego JJ
        • Nuñez-Gil IJ
        • et al.
        Aortic dissection caused by intra-aortic balloon pumping.
        Eur Heart J. 2014; 35: 1718
        • Miles LF
        • Roscoe AJ.
        Retrograde Type B Aortic dissection caused by intraaortic balloon counterpulsation.
        Anesth Analg. 2019; 129: e66-e68
        • Iverson LI
        • Herfindahl G
        • Ecker RR
        • et al.
        Vascular complications of intraaortic balloon counterpulsation.
        Am J Surg. 1987; 154: 99-103
        • Elahi MM
        • Chetty GK
        • Kirke R
        • et al.
        Complications related to intra-aortic balloon pump in cardiac surgery: a decade later.
        Eur J Vasc Endovasc Surg. 2005; 29: 591-594
        • Mand'ák J
        • Lonský V
        • Dominik J
        • et al.
        Vascular complications of the intra-aortic balloon counterpulsation.
        Angiology. 2005; 56: 69-74
        • Erdogan HB
        • Goksedef D
        • Erentug V
        • et al.
        In which patients should sheathless IABP be used? An analysis of vascular complications in 1211 cases.
        J Card Surg. 2006; 21: 342-346
        • Arafa OE
        • Pedersen TH
        • Svennevig JL
        • et al.
        Vascular complications of the intraaortic balloon pump in patients undergoing open heart operations: 15-year experience.
        Ann Thorac Surg. 1999; 67: 645-651
        • Meharwal ZS
        • Trehan N.
        Vascular complications of intra-aortic balloon insertion in patients undergoing coronary reavscularization: analysis of 911 cases.
        Eur J Cardiothorac Surg. 2002; 21: 741-747
        • Wolff T
        • Stulz P.
        Successful surgery for perforation of the thoracic aorta caused by the tip of an intra-aortic balloon pump.
        Eur J Cardiothorac Surg. 1997; 11: 1176-1179
        • Shiraishi R
        • Okazaki Y
        • Naito K
        • et al.
        Perforation of the descending aorta by the tip of an intra-aortic balloon pump catheter.
        Circ J. 2002; 66: 423-424
        • Cohen M
        • Dawson MS
        • Kopistansky C
        • et al.
        Sex and other predictors of intra-aortic balloon counterpulsation-related complications: prospective study of 1119 consecutive patients.
        Am Heart J. 2000; 139: 282-287