A successful percutaneous removal of a ruptured and detached intra-aortic balloon pump with vascular entrapment

Abstract

Introduction: Intra-aortic balloon pump (IABP) rupture and entrapment is a rare complication which may necessitate major surgery. Case report description: A 74 years old man was admitted to our hospital for coronary angiography (CA) after successfull rescucitation. The CA revealed a 95% left main stenosis with an occluded first obtuse marginal branch and an occluded right coronary artery. Emergent coronary artery bypass grafting was performed. The patient remained stable under the support of IABP (7Fr 40cc RediGuard IAB, Arrow International Inc. USA) until the fourth post-operative day, when a dysfunction of the IABP was noted. After several attempts to remove IABP at the patient's bedside, urgent fluoroscopy performed and showed the detached tip of intra-aortic balloon at the proximal third of the right common iliac artery (RCIA) and the IABP catheter shaft more distal. Left brachial artery (LBA) aortography revealed total occlusion of the RCIA. A pediatric balloon (8mm x 30mm Opta Pro Balloon,Cordis, Miami, FL) was advanced through the LBA to the proximal level of the RCIA, which was dilated and thus, facilitated IABP removal. Although no arterial dissection or rupture was observed, occlussive thrombi were visualized through the RCIA. Despite multiple dilatations with the balloon, total occlusion of RFA was ultimately demonstrated. Surgical thrombectomy was then, performed to restore patency and blood flow. ![Figure][1] Figure 1. Procedure and findings of IABP removal Discussion: A plausible mechanism for balloon rupture and thrombosis is its compression against calcified atherosclerotic plaques. Attempted forceful extraction or IABP technical deffect may have contributed to the detachment of the balloon from IABP catheter shaft. Conclusion: Percutaneous interventions may resolve successfully vascular complications during IABP support. [1]: pending:yes