Key result
Transbrachial 7 Fr IABP successfully supports a patient with severe LV dysfunction and bilateral iliac occlusion.
Why the study?
Femoral IABP insertion is usually contraindicated in severe peripheral vascular disease, and transbrachial IABP insertion has rarely been reported outside of percutaneous coronary intervention or coronary artery bypass grafting.
Case Report (n=1)
A left transbrachial percutaneous approach for IABP insertion may be a safe and effective alternative when femoral artery access is contraindicated due to severe peripheral vascular disease.
Answers are grounded in this paper and cite their sources.
May offer alternative IABP access in iliac occlusion; single case leaves open need for prospective safety data.
The intra-aortic balloon pump (IABP) was first successfully used by Kantrowitz and colleagues in 1968 . Traditionally, IABPs are inserted via the femoral artery. However, this approach is usually contraindicated in patients with severe peripheral vascular disease (PVD). Noël and colleagues were the first to report transbrachial insertion of an 8 Fr IABP catheter for ventricular assistance during percutaneous coronary intervention. However, in almost all the reported cases in which transbrachial insertion of an IABP was performed, it was done for hemodynamic support during percutaneous coronary intervention or coronary artery bypass grafting. We present a case involving a patient with endocarditis-associated structural aortic valve deterioration and severe left ventricular dysfunction, as well as total occlusion of both external iliac arteries. The patient was successfully treated using a 7 Fr transbrachial IABP. A left transbrachial percutaneous approach may thus be a safe and effective alternative if femoral artery access cannot be achieved.
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Kasai et al. (2020) conducted a case report in Endocarditis-associated structural aortic valve deterioration, severe left ventricular dysfunction, and total occlusion of external iliac arteries (n=1). Transbrachial intra-aortic balloon pump (IABP) was evaluated on Procedural success. A 7 Fr transbrachial intra-aortic balloon pump was successfully used for hemodynamic support in 1 patient with severe left ventricular dysfunction and bilateral external iliac artery occlusion.
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