In Which Patients Should Sheathless IABP be Used? An Analysis of Vascular Complications in 1211 Cases

Abstract

PAD, DM, and sheathed insertion technique are the major risk factors of ischemia during IABP use. Among all these risk factors, the only modifiable risk factor is the use of introducer sheath. With the presence of PAD and DM, the choice of sheathed method would increase the probability of ischemia almost 35 times. Sheathless method of insertion should be preferred in patients with DM and PAD.

Intra-Aortic Balloon Counterpulsation in Contemporary Practice – Where Are We?

“…Severe peripheral vascular disease represents the most important risk factor for vascular complications which, in turn, constitute the largest proportion of all IABP-related complications [16,[18][19][20][21][22].…”

2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)

“…Ważnym czynnikiem ryzyka tego powikłania jest LEAD, a wstępne zastentowanie tętnicy biodrowej z użyciem urządzenia bezkoszulkowego może pozwolić na uniknięcie takich powikłań [420]. Te powikła-nia są również częste u pacjentów leczonych urządzeniami do wspomagania czynności lewej komory, których koszulki naczyniowe są zwykle większe, co powoduje zwiększenie śmiertelności 30-dniowej u osób z LEAD [421].…”

IABP-Related vascular complications: Who is responsible — the patient, the surgeon or the sheath? Part I: Sheath-related complications

“…4,5 Sheaths can allow easy placement of the catheter and reduce the risk of haemorrhage at the site of arterial entrance. However, the use of a sheath can decrease the luminal surface of the IABP for distal blood flow and lead to a slow flow area that can result in thrombus production 6 -an effect which could be lessened when a sheathless catheter is used. Erdogan et al 6 has previously reported that the cross-sectional area of the IABP without sheath is 7.87 mm 2 whereas it is 11.53 mm 2 with sheath usage, corresponding to a 31.7% increase in the cross-sectional area of the IABP with a sheath.…”

“…However, the use of a sheath can decrease the luminal surface of the IABP for distal blood flow and lead to a slow flow area that can result in thrombus production 6 -an effect which could be lessened when a sheathless catheter is used. Erdogan et al 6 has previously reported that the cross-sectional area of the IABP without sheath is 7.87 mm 2 whereas it is 11.53 mm 2 with sheath usage, corresponding to a 31.7% increase in the cross-sectional area of the IABP with a sheath. This increase in the cross-sectional area, as expected, can be associated with a decrease in distal blood flow and consequently an increase in the risk of thrombus formation in the extremities.…”

“…3,7,10 In a retrospective study, Erdogan et al reported the comparison of both methods in patients with peripheral arterial disease, diabetes mellitus, a tendency toward ischaemia and a tendency toward thrombosis. 6 In our retrospective study we aimed to determine sheath-related complications in a group of cardiovascular surgical patients (with no accompanying health risk factors) following IABP application by comparing sheathed and sheathless IABP applications.…”