Endovascular balloon occlusion for catheter‐induced large artery perforation in the catheterization laboratory

Abstract

Vessel perforation is a complication that cannot be completely avoided in the setting of endovascular procedures. When a large noncompressible artery is disrupted, uncontrolled bleeding may lead to hemodynamic collapse. Endovascular occlusion may provide rapid control of hemorrhage and facilitate definitive therapy; yet, occlusion balloons are not commonly utilized in the cardiac catheterization laboratory. We describe our experience with the use of dedicated occlusion balloons for the management of catheter-induced major bleeding events. Endovascular occlusion was utilized to control severe bleeding in five patients with perforation of the aorta, iliac, femoral, or pulmonary artery. Acute control of hemorrhage was achieved in all patients with hemodynamic stabilization in four of five cases. Endovascular balloon occlusion facilitated definitive therapy with surgical repair in two patients, covered stent deployment in one patient and transcatheter vessel occlusion in one patient. Care was withdrawn in one elderly patient with multiple comorbidities. All four patients who survived the procedure were discharged alive from the hospital. In most cases of severe catheter-induced bleeding, endovascular balloon occlusion provide a safe, rapid, and effective means of temporary bleeding control.