Intra-aortic balloon pump rupture and metallic frame entrapment requiring complex retrieval and hybrid repair

A 50-year-old woman required an emergent operative exploration after an unsuccessful attempt at bedside removal of a ruptured intra-aortic balloon pump (IABP). Initial fluoroscopy demonstrated that the IABP tip moved dynamically with blood flow, but retraction and advancement caused significant bowing of the proximal external iliac artery. After unsuccessful endovascular snaring and resheathing, an exploratory laparotomy was required to remove the entrapped IABP via a longitudinal external iliac arteriotomy. Proximal to the patch angioplasty, an occlusive dissection flap was identified, requiring stent placement. Back table examination showed an exposed metallic knob, concerning for a manufacturing or iatrogenic defect, that likely caused this complication. The patient's health care proxy consented to the publication of this patient's operative course.