Mechanisms and prevention of arterial injuries caused by balloon embolectomy

In summary, this article reviews the spectrum of clinical injuries produced by balloon embolectomy The concepts of lateral wall pressure and balloon-artery shear force are presented, and the histologic reactions to passage of embolectomy catheters are described. On the basis of the results of experimental investigations, technical recommendations are made regarding the performance of embolectomy in patients. Attention to these technical details will prevent excessive shear forces and should decrease the incidence of catheter-induced vascular injuries. The following are recommended for performance of balloon embolectomy in patients: 1. Select smallest-sized catheter that will be effective. 2. Use small-bore, long-stroke syringe, such as tuberculin syringe. 3. Whenever possible, fill embolectomy balloons with fluid; air may be preferable in 2F catheters. 4. Before insertion into vessel, fill balloon to check for leaks and for eccentricity. 5. Reject balloons that leak or are markedly eccentric. 6. Insert catheter into vessel, taking care to enter true lumen; do not create false passage. 7. Do not force catheter against resistance: this may cause arterial perforation. 8. Begin to withdraw catheter before balloon is inflated; within first centimeter of motion, inflate balloon. 9. Withdraw catheter slowly and, if possible, continuously. 10. Repeat until lumen is clear, but do not pass catheter excessive number of times. 11. Obtain intraoperative completion arteriogram.