Myointimal hyperplasia as a result of balloon-catheter thromboembolectomy

The balloon-tipped embolectomy catheter is widely utilized in the treatment of arterial thromboemboli, significantly improving mortality and limb salvage rates. However, early and late complications related to catheter-tip injury and balloon trauma continue to occur and compromise the results of surgical intervention. Myointimal hyperplasia is an example of an unusual late complication induced by balloon-related arterial wall trauma. Myointimal hyperplasia is a commonly recognized healing response of the arterial wall to endothelial injury but is rarely reported after balloon-catheter thromboembolectomy. The extensive nature of the injury increases the incidence of limb loss. The pathophysiologic nature of this process is reviewed, and pertinent structural details such as intimal thickening and disruption of the internal elastic lamina are presented. The pathogenesis of myointimal hyperplasia suggests guidelines for catheter use during embolectomy that may further reduce the incidence of this unusual complication.