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Ex-vivo percutaneous bypass: Limb perfusion in the setting of occlusive large bore sheath

Zeel Shah1, M Chadi Alraies1, Mohamad Soud2

  • 1School of Medicine, Wayne State University, Detroit Medical Center, Detroit, Michigan.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|December 15, 2018
PubMed

Successful cardiac catheterization procedure begins with safe vascular access and ends with effective hemostasis after equipment removal. These new and advanced technologies in the cath lab require large-bore arterial accesses. Large-bore sheaths are associated with blood flow obstruction resulting in limb ischemia. In this case we present a 48-year-old woman was admitted NSTEMI and cardiogenic shock requiring mechanical circulatory support. Selective left common iliac angiography demonstrated obstructive flow at the level of the left CFA (access site). Therefore, ipsilateral bypass circuit was done. The current case illustrates the utility of a temporary ex-vivo bypass circuit to preserve limb perfusion in the presence of an occlusive large bore sheath. The technique permits sufficient hemodynamic support while maintaining limb perfusion and can be used for any occlusive large bore sheath.

Keywords:
cardiogenic shockcoronary artery diseasemechanical circulatory supportperipheral vascular disease

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