eComment: Right axillary artery as an alternative route for intraaortic balloon pump catheter insertion in severe aortoiliac pathologies

Bursa Yüksek Ihtisas Education and Research Hospital, 16330 Bursa, Turkey.
Interactive Cardiovascular and Thoracic Surgery (Impact Factor: 1.16). 09/2009; 9(2):370-1. DOI: 10.1510/icvts.2009.207522A
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Available from: Senol Yavuz, Aug 26, 2015
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    • "However, this route is not suitable in patients with severe aortoiliac pathologies including severe occlusive aortoiliac disease and aortic and iliac aneurysmal disease or severe peripheral vascular disease. In these complicated settings, placement of IABP catheter may fail or cause complications due to limb ischemia [3]. The incidence of failure for IABP insertion through the femoral route is ranging from 13% to 21% [4] [5]. "
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    ABSTRACT: Background: Intra-aortic balloon pump (IABP) is the most widely used mechanical assist device for hemodynamic support in high risk patients undergoing cardiac surgery. The aim of our study was to confirm whether transaortic route is a suitable alternative to allow IABP insertion in patients with severe aortoiliac diseases. Methods: This study included 7 consecutive patients undergoing coronary artery bypass grafting for severe coronary artery disease associated with severe aortoiliac disease. These patients could not be weaned from cardiopulmonary bypass and required the IABP support, which were placed through the ascending aorta. IABP catheter was inserted indirectly through a separate saphenous vein graft anastomosed to the ascending aorta by an end-to-side manner under a partial occluding clamp and advanced to the desired position in the descending thoracic aorta and exteriorly brought into the subcutaneous tissues in the jugulum. Results: The procedure was successfully performed in all the patients. The mean duration of IABP support was 54.0 ± 13.4 hours. There were no in-hospital mortality and complications related to transaortic route. IABP removal did not require repeat sternotomy. At postoperative 6th month, multislice CT examination showed thrombotic occlusion at the remnant of the saphenous vein graft. Conclusions: This technique is a simple, reliable, and reproducible option in patients with severe aortoiliac disease in whom retrograde femoral route is not possible.
    Full-text · Article · Jan 2014 · The Scientific World Journal