IABP-Related vascular complications: who is responsible--the patient, the surgeon or the sheath? Part I: sheath-related complications.
ABSTRACT An intra-aortic balloon pump (IABP) is frequently used as a mechanical support during the treatment of low cardiac output syndrome. The use of a sheath during IABP treatment can be associated with ischaemic complications in the extremities. The aim of our study was to determine the isolated role of sheaths in the development of vascular complications following IABP catheterisation.
We evaluated a total of 81 patients who had received an IABP for haemodynamic stability, between January 2003 and October 2007, following cardiovascular surgery. To eliminate surgical-related variables, only patients with IABPs and size 8.5 or 9 French catheters (inserted by experienced cardiovascular surgeons using the percutaneous Seldinger technique) were included in the study. To eliminate patient-related variables, patients with a known risk factor for either thrombosis, embolus or peripheral arterial disease were excluded from the study.
The patients were divided into two groups: Group 1 (sheathed catheter group; n=42), Group 2 (sheathless catheter group; n=39). Ischaemic complications were observed in a total of five patients. Four of these patients were from Group 1 and one was from Group 2.
Sheathed catheterisation was found to increase the risk of vascular complications in patients who underwent IABP application. Therefore sheathless catheterisation is recommended for IABP application.
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ABSTRACT: The purpose of our study is to compare the results of the sheathed and sheathless techniques for intraaortic balloon pump (IABP) insertion and to determine the rate of vascular complications in both conditions. A total of 1211 patients were examined representing a period of 19 years. Three hundred five sheathless (Group I) and 906 sheathed (Group II) IABP catheters were evaluated retrospectively. Data were analyzed with univariate analysis and logistic regression. Relative risk (RR) values were calculated in order to examine the effect of sheath. Limb ischemia was seen in 129 patients (10.9%). Although the incidence of peripheral arterial disease (PAD) was relatively higher in Group I (11.1% vs. 3.6%), the ischemic complication rate was lower in Group I (5.2% vs. 12.4%; p = 0.001). Presence of PAD (p = 0.001) and diabetes mellitus (DM) (p = 0.007) was found to be the risk factors of ischemia related to IABP use in all cases. In logistic regression analysis, presence of PAD, DM, and sheathed method was found to be the risk factors of ischemia. The patients who had all of these risk factors suffered from limb ischemia (RR value: 35.17). 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.Journal of Cardiac Surgery 01/2006; 21(4):342-6. · 1.35 Impact Factor
- Transactions - American Society for Artificial Internal Organs 02/1962; 8:85-9.
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ABSTRACT: The benefits of intra-aortic balloon pumping (IABP) usage reportedly occur through systolic unloading of the left ventricle and the augmentation of diastolic coronary flow. The aim of this study was to assess the change in intracoronary pressure distal to the coronary stenosis after the IABP by using an intracoronary pressure wire. Hemodynamic variables and intracoronary pressure data were measured in 16 patients requiring IABP for clinical indication (11 vessels with coronary stenosis and 5 normal vessels were enrolled). Coronary pressure was measured directly in each vessel with and without IABP support. The diastolic aortic pressure during IABP increased compared with that without the IABP (97.9 +/- 11.7 vs 80.3 +/- 10.7 mm Hg, P < .01). The systolic aortic and intracoronary pressure during the IABP decreased (aortic pressure: 83.8 +/- 10.4 vs 95.9 +/- 11.3 mm Hg, P < .01, intracoronary pressure: 67.6 +/- 16.5 vs 76.2 +/- 20.4 mm Hg, P < .01). The diastolic distal coronary pressure (Pd) increased during the IABP in healthy coronary arteries (87.3 +/- 4.8 vs 72.1 +/- 10.3 mm Hg, P < .05). However, Pd in stenotic coronary arteries with the IABP did not increase statistically compared with those without the IABP (44.0 +/- 21.3 vs 42.8 +/- 17.9 mm Hg). There was a significant correlation between the change in Pd after IABP insertion and percent diameter stenosis calculated by quantitative coronary angiography (r2 = 0.51, P < .001). In the presence of a critical coronary stenosis, the IABP does not increase the diastolic coronary pressure distal to the stenosis. Thus, the major effect of IABP on high-risk patients with severe coronary stenosis may relate to the reduction of oxygen demand by systolic unloading more than diastolic augmentation of the coronary flow.American heart journal 10/2007; 154(4):725-31. · 4.65 Impact Factor