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Vascular complications related to percutaneous insertion of intraaortic balloon pumps
1Cardiovascular Surgery Department, Türkiye Yüksek Ihtisas Hospital, Ankara.
Insights
Vascular complications from intraaortic balloon pumps (IABPs) are common, especially with percutaneous insertion. Identifying at-risk patients, including diabetics and those with peripheral vascular disease, is crucial for safer IABP use.
Area of Science:
- Cardiology
- Vascular Surgery
- Medical Devices
Background:
- Intraaortic balloon pumps (IABPs) are critical for hemodynamic support.
- Vascular complications are a significant concern with IABP use, particularly with percutaneous insertion.
- Predicting and mitigating these complications is essential for patient outcomes.
Purpose of the Study:
- To evaluate vascular complications associated with percutaneous IABPs.
- To identify risk factors for vascular complications in IABP patients.
- To assess the effectiveness of an algorithm for predicting these complications.
Main Methods:
- Retrospective analysis of 449 patients receiving percutaneous IABPs.
- Evaluation of vascular complication rates and associated risk factors.
- Comparison of complication rates between sheathless and sheathed IABPs.
Main Results:
- Vascular complications occurred in 17.4% of patients, with significantly higher mortality (65.7% vs. 50.8%).
- Diabetics (RR 2.5), females (RR 1.83), peripheral vascular disease (RR 3.69), and CABG patients (RR 2.08) had increased risk.
- No significant difference in complications between sheathless and sheathed IABPs.
Conclusions:
- Percutaneous IABP insertion is associated with significant vascular complications and increased mortality.
- Specific patient demographics and comorbidities identify high-risk individuals.
- Pre-insertion risk assessment is vital; alternative insertion routes may be preferred for IABP-dependent patients.
Abstract:
The hemodynamic effects of intraaortic balloon pumps (IABPs) are well known. The use of IABPs is prone to many complications, including those classified as vascular. These complications are said to be more frequent with percutaneous insertion techniques. These complications and the algorithm for identifying patients who are most likely to suffer vascular complications were evaluated in a retrospective manner in a group of patients that received percutaneous IABPs. The study group consisted of 449 patients. The mean age of these patients was 53.6 +/- 12.8 years (range, 18 to 80 years), and 24.7% were female. The early mortality rate of these patients was 53.2%. The mortality for patients in whom vascular complications developed was significantly higher than that in the patients who did not suffer any vascular complications (65.7% versus 50.8%; p = 0.018). Minor or major vascular complications developed in 17.4% (n = 78) of the patients. There was no statistical difference in the frequency of complications between the patients who received a sheathless IABP and those who received a sheathed IABP. Ischemic complications occurred in 16.6% of the patients who received a sheathless IABP and in 17.6% of the patients with sheathed IABPs (p < 0.05). Diabetic patients (relative risk, 2.5), female patients (relative risk, 1.83), patients with peripheral vascular disease (relative risk, 3.69), and patients undergoing coronary artery bypass operations (relative risk, 2.08) were at increased risk for suffering vascular complications. These risk factors should be evaluated before insertion of an IABP, and routes other than percutaneous femoral insertion are preferred if the patient is IABP dependent.