Distal Embolic Protection in Impella 5.0 Explantation: Loop and Snare Technique

The left ventricular assist device Impella 5.0 (Abiomed Inc, Danvers, MA) has become widely accepted as a temporary mechanical circulatory support for patients in cardiogenic shock. The Impella 5.0 is placed through an anastomosed graft. When removing the device, blood clot formation has been noted in the anastomosed graft. The blood clot has been reported to dislodge and embolize distally, causing acute limb ischemia. Here, we present our simple, inexpensive, and effective "loop and snare" technique for safer device removal, preventing distal embolic complications. In our experience of 6 patients who had Impella 5.0 removal with this technique, the distal embolic complication was 0%.