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[Left subclavian artery approach for insertion of IABP]
N Murai1, T Kaneko, T Oobayashi
1Division of Cardiovascular Surgery, Gunma Prefectural Cadiovascular Center, Maebashi, Japan.
Insights
This study highlights the successful use of a left subclavian artery approach for intra-aortic balloon pump (IABP) insertion in a patient with severe coronary artery disease and arteriosclerosis obliterans (ASO). The minimally invasive technique facilitated emergency cardiac surgery.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Interventional Cardiology
Background:
- A 62-year-old male presented with chest pain, diagnosed with three-vessel coronary artery disease and ventricular dysfunction (EF 40%).
- The patient also had arteriosclerosis obliterans (ASO), complicating potential treatment strategies.
- Worsening chest pain necessitated urgent hemodynamic support prior to planned coronary artery bypass grafting (CABG).
Observation:
- Intra-aortic balloon pump (IABP) catheter insertion was indicated for stabilization.
- A left subclavian artery approach was selected for IABP access due to the patient's ASO.
- The IABP catheter was successfully inserted into the descending aorta under fluoroscopic guidance.
Findings:
- Emergency CABG was performed the day following IABP insertion.
- The IABP was removed uneventfully the morning after surgery.
- Both IABP insertion and removal were successfully accomplished under local anesthesia.
Implications:
- The left subclavian artery approach offers a viable alternative for IABP insertion in patients with peripheral artery disease, including ASO.
- This minimally invasive strategy can facilitate timely emergency cardiac procedures.
- Successful management underscores the utility of the left subclavian approach in complex vascular cases.
Abstract:
A 62-year-old man admitted with a complication of chest pain. Cardiac catheterization showed three vessel disease with ventricular dysfunction (EF 40%). And aortagram showed that he had arteriosclerosis obliterans (ASO). While he was waiting for operation, the frequency of chest pain increased. It was considered necessary for him to have IABP catheter inserted. We chose left subclavian artery as an access for the insertion of IABP catheter. The catheter was easily introduced into the descending aorta under the fluoroscopy. Emergency CABG was performed the day after insertion of IABP catheter. IABP removed the next morning of operation. Operation and postoperation course was uneventful. In this case, the insertion and the removal were possible under local anesthesia. Left subclavian approach was useful for emergency case with ASO.