Percutaneous intra-aortic balloon insertion is associated with a 17.8% rate of failure to completely unwrap, which usually requires withdrawal, re-wrapping, and reinsertion or replacement.
High unwrap failure with perioperative IABP warrants insertion technique caution; leaves open optimal protocols and outcome impact in larger studies.
An intra-aortic balloon which can be inserted percutaneously has become an attractive adjunct in the past few years. The major benefits of this technique are ease and speed of insertion and the lack of need for a surgical cutdown. Early concerns about post balloon removal hemorrhage due to the large catheter size (12 French) have largely proven to be unfounded. Early experience suggests that the most frequent problem associated with percutaneous insertion has been failure of the balloon to completely unwrap. This problem was observed in 17 of 96 patients (17 .8%) in whom the balloon was inserted perioperatively. Usually, the problem is recognized immediately. The balloon is then withdrawn, re-wrapped, and reinserted or replaced with another balloon. In two patients, failure to completely unwrap was not recognized until later. One patient had the balloon removed while another was simultaneously inserted into the contralateral femoral artery without complication followed by improved and normal balloon function. The second patient is presented depicting recognition of the problem and subsequent solution.
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Curtis et al. (1983) studied this question.
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