Modification of intraaortic balloon catheter to permit introduction by cardiac catheterization techniques

Optimization and safety of the intra-aortic balloon pumping balloon catheter

Tokai Medical Products developed an intra-aortic balloon pumping (IABP) balloon catheter with the following unique characteristics: the balloon can be applied to any patient irrespective of their physical size, and is therefore suitable for Japanese patients of small stature; a long soft tip is used, which is designed to avoid damage to blood vessels; the size of the catheter is reduced to 7 Fr, and the catheter can be used as a multifunctional balloon catheter, such as the Yoshioka type, that allows simultaneous percutaneous coronary intervention (PCI). The safety of this catheter has been proven in scientific studies. In this review, we report the development of our IABP balloon catheter and give an outline of its characteristics.

Successful treatment of an iatrogenic infrarenal aortic dissection with serial Wallstents

We report a patient who presented with acute lower extremity ischemia 13 days following removal of an intraaortic balloon pump. Dissection of the infrarenal aorta, extending into the left iliac artery, was found at operation. The patient's recent myocardial infarction, prolonged ischemia with compartment syndrome, otherwise normal aortoiliac and infrainguinal arteries and the necessity for suprarenal aortic clamping for surgical repair, were all factors in the decision for endovascular repair of the dissection. Infrarenal aortic and left iliac Wallstents, placed intraoperatively, successfully occluded the false lumen of the dissection. The patient was discharged after an uncomplicated recovery and is asymptomatic with palpable pedal pulses and triphasic pedal Doppler waveforms 1 year following the procedure.

Vascular complications of intraaortic balloon pumping: unsheathed versus sheathed insertion

Incidence of vascular complications in intraaortic balloon counterpulsation is still high despite major refinements in catheter design and techniques. One hundred twenty-six patients in whom intraaortic balloon pumping was attempted were divided into two groups on the basis of insertion technique. Group 1 included 77 patients in whom the conventional percutaneous insertion was used. In group 2 (n = 45 patients), a sheathless insertion technique was used. The overall vascular complication rate was 19.6%, with the lower limb ischemia as the most common complication. The vascular complication rate was 25.9% in group 1 and 8.8% in group 2 (p < 0.01). Lower limb ischemia was noted in 17 patients in group 1 and 3 patients in group 2 (p < 0.01). These results suggest that sheathless insertion of the intraaortic balloon pump catheter can minimize vascular complications. This technique will be especially useful in patients with peripheral vascular disease, in whom the likelihood of vascular complications is high.

A new technique for sheathless percutaneous intraaortic balloon catheter insertion

Intraaortic balloon counterpulsation is helpful for controlling myocardial ischemia and providing hemodynamic support, but its applicability is limited by lower extremity ischemic complications in a significant percentage of patients. We developed a new sheathless technique for percutaneous intraaortic balloon catheter insertion which reduces the effective catheter diameter. A pilot study using this new technique resulted in a 10% rate of limb ischemia, without compromise of balloon function. We conclude that this technique may be useful in reducing the incidence of limb ischemia associated with intraaortic balloon counterpulsation.

Percutaneous intraaortic balloon pumping: four years from Tiblisi

Intraaortic balloon pumping (IABP) has now evolved as the mechanical supportive treatment of choice for the management of refractory left ventricular power failure. A new single-chambered percutaneous intraaortic balloon (Datascope Corp., Paramus, NJ, U.S.A.) has been constructed around a central guidewire. The balloon can be wrapped around the guidewire, enabling its insertion into the femoral artery through a 12-F sheath, inserted by a modified Seldinger technique. A dual-lumen automatic wrapping version has recently been employed. Percutaneous IABP insertion has been performed in 149 patients (mean age 58 years). In our medical group of 75 patients, 59 underwent urgent open heart surgery and 53 (90%) survived. In patients who could not be separated from cardiopulmonary bypass, 23 of 61 (38%) survived. Vascular complications occurred in 10% of the patients. Percutaneous balloon insertion permits the rapid institution of IABP support and broadens the medical and surgical applications of IABP.

Intraaortic balloon pump morbidity: a comparative analysis of risk factors between percutaneous and surgical techniques

We reviewed our concurrent experience with percutaneous insertion versus surgical placement of the intraaortic balloon pump over a two-year period both to compare morbidity and to provide guidelines for the choice of method in particular patient groups and clinical settings. The effects on morbidity of sex, age, emergency placement, coexisting peripheral vascular disease, and duration of counterpulsation were determined. Sex was a highly significant factor, with low complication rates (3/29 or 10.3%) for percutaneous insertion in men and an inordinately high morbidity (12/17 or 70.6%) in women (Fisher exact test: p = 4.611 X 10(-5)). This difference may be due to the smaller size of the femoral artery in women. We conclude that percutaneous insertion is the preferred technique for most men but that direct exposure of the femoral artery should be employed in women. Given the serious morbidity encountered with each technique, there is no justification to broaden the indications for intraaortic balloon counterpulsation.

Comparison of wire-guided percutaneous insertion and conventional surgical insertion of intra-aortic balloon pumps in 151 patients

Over a 25-month period, percutaneous wire-guided balloon catheter insertion was attempted in 51 patients, and intra-aortic balloon pump insertion was attempted by conventional surgical method in 100 patients. The success rate in the group undergoing percutaneous insertion was 90.2 percent (46 of 51) and 90 percent in the group undergoing surgical insertion (90 of 100). The indications for intra-aortic balloon counterpulsation were diverse in both groups. The major complication rate in the patient population undergoing percutaneous intra-aortic balloon pump insertion was 15.2 versus 15.6 percent for the surgical group, and there were no cases of leg amputation or aortic dissection in the percutaneous group; however, two cases of leg amputation and one case of aortic dissection resulting in death occurred in the surgical group. The percutaneous intra-aortic balloon pump insertion technique was successfully employed in conjunction with percutaneous transluminal coronary angioplasty in six cases. It is concluded that the wire-guided percutaneous balloon catheter method is a highly successful and rapid means of instituting intra-aortic balloon counterpulsation in a wide variety of clinical situations. However, because of the significant associated complication rate, the decision to institute balloon counterpulsation must weigh the benefit-to-risk ratio, and this procedure must still be evaluated on a case-by-case basis.

Mechanical techniques of circulation support: a percutaneous intra-aortic balloon device

As medical indications for intra-aortic balloon (IAB) pumping expand, many physicians without surgical expertise are faced with the decision to institute circulatory support. Accordingly, to facilitate rapid establishment of cardiac assist and to obviate the need for operative insertion and removal, a 40-cc single-chambered device was designed for percutaneous insertion by the Seldinger technique. Hemodynamic augmentation produced by the percutaneous balloon is similar to that obtained with conventional IAB. It appears that complications related to IAB insertion may be decreased by the percutaneous method.

Percutaneous wire-guided balloon pumping

A percutaneous wire-guided double lumen intraaortic balloon pump was tested in 44 patients, 15 with cardiogenic shock. The balloon volume is 40 ml, the material is Avcothane, and the central lumen will pass a 0.035 inch (0.889 mm) wire guide. Standard Seldinger technique was followed by successful insertion in 40 patients (90 percent) with no recognized vascular trauma. Counterpulsation was excellent and central pressure monitoring through the balloon lumen showed good fidelity. Iliofemoral thrombosis occurred in 5 percent of patients. The overguide technique is simple, successful and atraumatic.

Percutaneous intraaortic balloon insertion

A new single chambered percutaneous intraaortic balloon has been constructed around a central guidewire. The balloon can be wrapped around the guidewire, enabling its insertion into the femoral artery through a 12F sheath inserted with the conventional Seldinger technique. Percutaneous intraaortic balloon insertion has been performed in 27 patients (mean age 58 years) for a variety of medical and surgical indications. Percutaneous balloons could not be advanced into the aorta in two patients (7.4 percent) with severe bilateral aortoiliac occlusive disease. In all 25 patients undergoing intraaortic balloon pumping satisfactory circulatory support was achieved, and 21 (84 percent) of the patients survived to be discharged from the hospital. The mean duration of intraaortic balloon pumping was 3.5 days. Percutaneous intraaortic balloon insertion requires less than 5 minutes and has been successfully performed in the cardiac catheterization laboratory, coronary care unit, operating room and recovery room. After direct balloon removal, external pressure was applied for 30 minutes. No patient experienced hematoma of the groin, aortic dissection, compromised distal pulses or late wound complications. Percutaneous balloon insertion permits the rapid institution of circulatory support and broadens the medical and surgical applications of intraaortic balloon pumping.