Abstract

LEVIN, Ricardo L. et al. Indications, Utilization and Complications Associated to the Antegrade Insertion of an Intraaortic Balloon Pump. Rev. argent. cardiol. [online]. 2006, vol.74, n.6, pp.367-371. ISSN 1850-3748.

Background When contraindications are present or the intraaortic balloon pump cannot be advanced from its usual femoral insertion site (retrograde), alternative routes of insertion are necessary. One option is the antegrade access through the subclavian (or axillary) route. Objective To assess the indications, utilization rate and complications associated with the antegrade access of an intraaortic balloon pump through the subclavian route. Material and Methods Patients subjected to intraaortic balloon pumping between January 1, 1998 and January 11, 2006, were included. The study focused on patients who underwent antegrade access. Contraindications for femoral access were the presence of an abdominal aortic aneurysm, a history of aortobifemoral bypass, an aortic endoprosthesis or angiographic proof of bilateral subocclusive iliofemoral lesions. If the catheter could not be advanced through the femoral route after three attempts, an alternative route was considered. Statistics: A p value < 0.05 was considered significant. Results Of a total of 782 implanted devices, 24 were inserted through the antegrade subclavian route (3.1%). Indications were abdominal aortic aneurysm in 13 patients (54.2%), prior aortobifemoral bypass in 5 cases (20.8%), aortic endoprosthesis in one patient (4.2%) and impossibility to progress through the retrograde route in the remaining 5 cases (20.8%). The general characteristics of the groups subjected to antegrade and retrograde access were comparable, except for an increase in the rate of intermittent claudication and peripheral vascular surgery in the first group. Fifty two patients had complications (6.6%): one in the antegrade access group (limb ischemia, 4.1%) compared to 51 complications in the retrograde access group (6.7%; p = ns). One hundred twenty nine patients died (16.5%), three of them in the antegrade access group (12.5%), compared to 126 deaths in the retrograde access group (16.6%; p = ns). Conclusions A 3.1% of implants were performed through the subclavian (antegrade) route. The most frequent indication for such access was the presence of an aneurysm of the abdominal aorta. Morbidity and mortality were similar to those seen with conventional insertion. The antegrade subclavian access is a valid option for patients who require intraaortic balloon pump support and in whom the conventional approach is contraindicated.

Keywords : Intraaortic balloon pump; Occlusive arterial disease; Aorta; Lower limb.