Intra-aortic balloon pump rupture and metallic frame entrapment requiring complex retrieval and hybrid repair

Figures

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  Fig 1. Fluoroscopy images showing intra-aortic balloon pump (IABP) entrapment and eventual Viabahn stent placement. The blue arrow indicates the common iliac artery, the red arrow indicates the external iliac artery, and the yellow arrow indicates the internal iliac artery. (A) IABP located in the distal aorta; (B) A Kumpe catheter could not be advanced past the mid to proximal external iliac artery; (C) The blue arrow is at the level of the dissection flap in the common iliac artery, and the red arrow is at the level of occlusion in the proximal external iliac artery; (D) Placement of a Viabahn stent in the external iliac artery to cover the dissection with patent distal flow.

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  Fig 2. Intra-aortic balloon pump (IABP) sent for pathologic examination. (A) Diagram with a yellow arrow highlighting the exposed metal structure at the beginning of the green balloon lodged into the media of the red arterial wall anteriorly. (B) Gross pathology noted the 10.7 × 7.2 × 1.6 cm white, plastic prosthetic device and IABP had attached soft tissue and blood clot. The green box indicates that the distal tip of the device was intact. The blue box indicates the proximal portion of the device system. The yellow arrows highlight the exposed metal structure at the beginning of the balloon, corresponding with the area highlighted in the blue box on the unused device (C).

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  Fig 3. Postoperative computed tomography angiography 1 week after intra-aortic balloon pump (IABP) removal. (A) Three-dimensional reconstruction of the aortoiliac system showed no evidence of abnormal aortic pathology with patent internal iliac arteries. (B) Small stable hematomas in the right groin and along the right common and external iliac arteries were without active extravasation. The right external iliac artery stent and patch angioplasty sites indicated by the red arrow remained patent. There was a small amount of residual thrombus in the right common iliac artery with mild stenosis indicated by the yellow arrow.