Significant vascular complications in percutaneous axillary intra-aortic balloon pump

This chapter describes the intra-aortic balloon pump (IABP), which is the single most widely used mechanical circulatory assist device available today. Counterpulsation refers to balloon inflation in diastole and deflation in early systole: this results in increased coronary blood flow, left ventricular afterload reduction, and increased end-organ perfusion. Other uses of balloon counterpulsation include refractory ventricular arrhythmias, inability to wean from cardiopulmonary bypass, bridge to intervention in severe/critical aortic stenosis, and refractory pulmonary edema from decompensated heart failure. However, the absolute contraindications for IABP placement are aortic dissection, clinically significant aortic aneurysm, severe peripheral artery disease, significant aortic regurgitation, uncontrolled bleeding, and/or sepsis. The chapter then explains the optimal positioning for IABP. It also looks at complications associated with IABPs. These include thrombocytopenia and vascular complications, such as limb ischemia, bleeding, dissection, and hematoma/pseudoaneurysm formation. The presence of blood in the balloon tubing suggests the possibility of balloon rupture and gas embolism, an extremely uncommon but catastrophic event.

Background: The use of the intra-aortic balloon pump (IABP) as a support device remains controversial due to the fact that a number of studies have shown no benefit in end mortality whilst using this device. One of the reasons for this could be the increase in vascular complications when using the pump. Therefore, the aim of the present review was to assess the current literature available with regards to IABP vascular complications during the clinical situation. Methods: A literature search was performed, searching for IABP complications in adult human studies between 1990 and 2016. Results: A total of 20 reports were identified as fitting the criteria of this study. The majority of vascular complications were limb ischemia, bleeding or mesenteric ischemia. The overall incidence of vascular complications ranged from 0.94% to 31.1%. Diabetes, peripheral vascular disease and hypertension, as well as smoking were all identified as risk factors for complications following IABP. Furthermore, studies supported the use of sheathless balloon insertion to reduce the risk of complications. Conclusion: Major vascular complications, including limb and mesenteric ischemia as well as bleeding and hemorrhage, have been associated with IABP. However, the incidence of these complications was generally low. Further studies are still required to truly understand the risk/benefit associated with the use of IABP.