Positional obstruction of the superior mesenteric artery by an intra-aortic balloon pump placed through subclavian artery approach.

Abstract

Patients awaiting orthotropic heart transplant (OHT) often require temporary mechanical circulatory support. Although the intra-aortic balloon pump (IABP) placed through percutaneous femoral arteriotomy is the most commonly used form of mechanical circulatory support in the United States, this approach requires the patient to remain immobile, making it suboptimal for extended use. Our center recently developed a novel technique to insert an IABP through the subclavian artery (SCA),1 allowing the patient to ambulate. Briefly, a polytetrafluoroethylene graft is anastomosed in an end-to-side fashion to the right or left SCA. A valve is secured within the other end of the graft, and the IABP is advanced through the graft into the descending aorta. The proximal radio-opaque IABP marker is positioned 2 cm superior to the carina with the distal marker near the L2 vertebra. Although several groups have reported various techniques for SCA IABP insertion,2,3 no consensus exists regarding the optimal position of the distal tip. We report 2 cases of IABP migration into the superior mesenteric artery (SMA) with associated bowel ischemia. A 60-year-old, 180 cm tall man with a Maquet 8F 50cc right SCA IABP complained of nonbloody diarrhea and severe abdominal pain radiating to the back 6 days after implant. He denied urinary symptoms and had no history of pancreatic, hepatic, or ulcerative disease. On physical examination, there was diffuse abdominal tenderness without peritoneal signs or distention. Bowel sounds were intact. Laboratories and ultrasonography of the liver, pancreas, and biliary system were unremarkable. Anteroposterior chest x-ray showed the …