Why the study?
Increased complication rates with axillary compared to femoral IABP insertion suggested anatomic variations may predispose patients to device failure.
Do specific vascular anatomic features measured on pre-insertion CT predict mechanical complications in patients receiving axillary intra-aortic balloon pumps as a bridge to heart transplant?
Do specific vascular anatomic features measured on pre-insertion CT predict mechanical complications in patients receiving axillary intra-aortic balloon pumps as a bridge to heart transplant?
Normal variations in vascular anatomy measured by routine CT do not appear to predict mechanical complications of axillary intra-aortic balloon pumps and should not preclude their use.
Answers are grounded in this paper and cite their sources.
No link between measured axillary anatomy and axIABP complications; leaves open whether unmeasured factors or technique drive failure in bridge-to-HTx patients.
BACKGROUND: Intra-aortic balloon pumps (IABP) are commonly used as a bridge to heart transplant (Htx). Although IABPs were designed for transfemoral arterial placement, axillary IABPs (axIABP) allow for continued ambulation and rehabilitation. However, increased rates of device complications with axillary compared to femoral insertion suggest anatomic variations that predispose patients to device failure. METHODS: We conducted a single-center retrospective study of patients who received axIABP as a bridge to HTx between February 2018 and July 2022. Pre-axIABP computed tomography (CT) images were reviewed for all patients, and anatomic features of the axillary and central arteries were measured and correlated with mechanical axIABP complications. RESULTS: A total of 48 patients underwent successful axIABP placement with available pre-insertion CT images, of whom 35 (72.9%) were male. Out of 48 patients, 26 (54.2%) experienced 34 complications, including axIABP rupture (n = 10, 29%), infection (n = 8, 23%), and thrombosis (n = 6, 18%). CTs showed an average axillary artery diameter and depth of 6.79 and 55.6 mm, respectively. The average subclavian artery takeoff angle from the aortic arch was 95.4°. CONCLUSION: Of the 10 vascular anatomic features measured, there was no association between any single measurement and axIABP complications. However, there may be other structural features not measured by routine CT, technical issues with insertion, and device factors not accounted for in this study that drive axIABP complications. Nonetheless, our findings suggest that normal variations in the measured vascular anatomy should not preclude axIABP use.
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Valdes et al. (2025) studied this question.
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