Intra-aortic Balloon Pump Entrapment in a Transfemoral Sheath:Successful Management with Retrograde Transradial Wiring and Externalization

Abstract

Mechanical circulatory support by means of Intra-aortic Balloon Pump (IABP) is an established therapeutic means in high-risk patients undergoing coronary revascularization (e.g. due to severe left ventricular systolic dysfunction) or those with cardiogenic shock refractory to medical therapy. Despite its remarkable safety profile, complications during IABP deployment still occur, and may be life-threatening, especially because of the underlying risk of those receiving such device. Indeed, the IABP balloon may occasionally become entrapped in the transfemoral sheath during delivery. We hereby report a case in which IABP entrapment in a transfemoral sheath during initial delivery was successfully managed by means of retrograde wiring with an exchange-length 0.018" guide wire delivered through a transradial sheath. This clinical vignette provides evidence that a simple technical trick (i.e. retrograde tracking of 300 cm guide wire between the IABP shaft and the internal wall of the delivery sheath followed by guide wire externalization) may prove effective and safe in solving this potentially dangerous complication.