Intra-Aortic Balloon Pump Entrapment in a Nonatherosclerotic Common Iliac Artery

Abstract

Use of an intra-aortic balloon pump (IABP) is helpful for maintaining hemodynamic stability in patients with low cardiac output and compromised left ventricular function undergoing coronary artery bypass grafting. Although the incidence of complications has decreased significantly as experience with the device has increased, IABP use still carries a risk of complications. The most common complication is limb ischemia, mainly as a result of IABP entrapment and thromboembolism. Here we report a case of IABP entrapment in a nonatherosclerotic common iliac artery where forced removal caused fracture of the catheter.

Management of Intra-Aortic Balloon Pump Rupture and Entrapment

“…Naturally, the goal of management should be safe removal of the IABP. However, there have been documented cases of forceful extraction resulting in unintentional damage to the external iliac and common femoral arteries [6,7]. Complications arising from such methods have resulted in acute limb ischemia, the need for bypass surgery, and even death [6].…”

“…However, an open surgical approach has been the extraction modality of choice in recent times [6,8,9]. Open inguinal access to the femoral and/or iliac vessels is the mainstay approach for removal of the entrapped IABP due to the ease of access and possibility for safe extraction under direct vision, although successful trans-and retroperitoneal approaches have also been described [7,10]. As in our case, IABP rupture and entrapment often causes substantial damage to the iliofemoral arteries, necessitating vascular repair by endarterectomy, patch closure, or even bypass graft and resulting in significant morbidity for the patient.…”