Vascular complications following intra-aortic balloon pump implantation: an updated review

Abstract

Background:The use of the intra-aortic balloon pump (IABP) as a support device remains controversial due to the fact that a number of studies have shown no benefit in end mortality whilst using this device. One of the reasons for this could be the increase in vascular complications when using the pump. Therefore, the aim of the present review was to assess the current literature available with regards to IABP vascular complications during the clinical situation.Methods:A literature search was performed, searching for IABP complications in adult human studies between 1990 and 2016.Results:A total of 20 reports were identified as fitting the criteria of this study. The majority of vascular complications were limb ischemia, bleeding or mesenteric ischemia. The overall incidence of vascular complications ranged from 0.94% to 31.1%. Diabetes, peripheral vascular disease and hypertension, as well as smoking were all identified as risk factors for complications following IABP. Furthermore, studies supported the use of sheathless balloon insertion to reduce the risk of complications.Conclusion:Major vascular complications, including limb and mesenteric ischemia as well as bleeding and hemorrhage, have been associated with IABP. However, the incidence of these complications was generally low. Further studies are still required to truly understand the risk/benefit associated with the use of IABP.

Vascular complications in adult postcardiotomy cardiogenic shock patients receiving venoarterial extracorporeal membrane oxygenation

“…Therefore, for the patients with femoral artery stenosis (moderate to severe), surgical cut-down combined with a distal perfusion tube for implantation of VA-ECMO is recommended. Although the incidence of limb ischemia was generally low, IABP has the risk of increasing the risk of limb ischemia [ 26 ]. A total of 246 patients (56.9%) received VA-ECMO combined with IABP support.…”

Thrombogenic and Inflammatory Reactions to Biomaterials in Medical Devices

“…The most frequent complication of intra-aortic balloon pumps used in critically ill patients with compromised cardiac function (cardiogenic shock, acute myocardial infarction, left ventricular ejection fraction <35%) is limb ischemia needing thrombectomy with an incidence of 0.9 to 26.7% (De Jong et al, 2018). Thrombosis, a common complication of subclavian intra-aortic balloon pumps (Naqvi et al, 2018), is associated with mCRP production after platelet activation and microparticle generation (McFadyen et al, 2018).…”

Mechanical Support in Early Cardiogenic Shock: What Is the Role of Intra-aortic Balloon Counterpulsation?

“…Compared with other MCSDs like micro-axial pVADs (Impella, Abiomed, Danvers, MA; USA) and Tandem Heart (CardiacAssist Inc., Pittsburgh, PA, USA), extracorporeal centrifugal-flow LVAD, and VA-ECMO, complication rates of IABP are low. The reported incidence of adverse events in femoral IABP implantation ranges between 0.9 and 31.1% [ 26 •, 27 , 28 •, 29 , 30 ••], but these rates also include minor adverse events (e.g., access site hematoma, transient loss of pulsations, or need for blood transfusion). The most frequent device-related complication is (most often reversible) limb ischemia with a roughly estimated incidence of 5% (range from 0.9 to 26.7%) [ 27 , 29 , 31 ].…”

“…The reported incidence of adverse events in femoral IABP implantation ranges between 0.9 and 31.1% [ 26 •, 27 , 28 •, 29 , 30 ••], but these rates also include minor adverse events (e.g., access site hematoma, transient loss of pulsations, or need for blood transfusion). The most frequent device-related complication is (most often reversible) limb ischemia with a roughly estimated incidence of 5% (range from 0.9 to 26.7%) [ 27 , 29 , 31 ]. However, we have to consider that complications may be the result of the CS itself, since the complication rate in IABP supported patients was equal compared with controls in IABP-SHOCK [ 31 ].…”