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Complications of intra-aortic balloon counterpulsation, with special reference to limb ischemia
1Department of Anesthesiology, University Hospital, Uppsala, Sweden.
Insights
Intra-aortic balloon pumping (IABP) has a poor prognosis, with 20% experiencing limb ischemia. Open catheter removal is recommended for hemostasis and to prevent complications.
Area of Science:
- Cardiology
- Vascular Surgery
- Critical Care Medicine
Background:
- Intra-aortic balloon pumping (IABP) is a mechanical circulatory support device used in patients with severe heart conditions.
- The Seldinger technique is commonly employed for percutaneous catheter insertion, including for IABP.
- Complications associated with IABP, such as limb ischemia and hematoma, require careful management.
Purpose of the Study:
- To evaluate the outcomes and complications of intra-aortic balloon pumping (IABP) in patients undergoing open-heart surgery.
- To compare the incidence of limb ischemia and hematoma based on different IABP catheter insertion and removal techniques.
- To provide recommendations for optimal IABP catheter management in various clinical scenarios.
Main Methods:
- A retrospective analysis of 90 patients who received IABP via Percor catheter using the Seldinger technique over a 5-year period.
- Assessment of postoperative outcomes, including survival rates and incidence of limb ischemia and groin hematoma.
- Comparison of percutaneous versus 'open' catheter insertion and removal techniques.
Main Results:
- Overall survival at 23 months was 51% (46/90 patients).
- Limb ischemia occurred in 20% of patients, irrespective of insertion technique.
- Groin hematoma was more frequent with percutaneous catheter extraction, while 'open' removal was hemostatic and allowed for embolectomy.
Conclusions:
- Percutaneous femoral artery insertion is suitable for emergency IABP, while 'open' Seldinger technique is preferred in the operating room.
- 'Open', hemostatic catheter removal is recommended for elective procedures to minimize complications.
- Prompt catheter removal is crucial for limb-threatening ischemia; alternative access routes should be considered for IABP-dependent patients.
Abstract:
During a 5-year period, intra-aortic balloon pumping (IABP) was performed on 90 patients (3.1% of those undergoing open-heart surgery), using a Percor catheter inserted with Seldinger technique. Overall prognosis was poor; only 46 of the 90 patients were alive at postoperative follow-up averaging 23 months. Limb ischemia arose in 20%, with incidence uninfluenced by catheter insertion technique (percutaneous v. 'open'). Surgical treatment was required for half of the ischemic limbs. Groin hematoma commonly followed percutaneous extraction of IABP catheter, whereas 'open' removal was always hemostatic, with potential for embolectomy. Percutaneous insertion of IABP catheter via the femoral artery is the method of choice in an emergency situation. 'Open' Seldinger technique is preferable in the operating room. For elective IABP catheter removal, the 'open', hemostatic technique is recommended. If limb-threatening ischemia develops, the catheter must be removed. If the patient is IABP-dependent, the contralateral femoral artery or the ascending aorta should be considered as an alternative catheter route.