Transbrachial insertion of a 7.5-Fr intra-aortic balloon pump in a severely atherosclerotic patient.
OBJECTIVE
Preoperative intra-aortic balloon pumping (IABP) improves the results of complex coronary surgery. However, its insertion may be harmful or contraindicated in cases of severe and diffuse atherosclerosis of the descending aorta and peripheral arteries. We sought to evaluate the efficacy and safety of transbrachial insertion of the new 7.5-Fr IABP to support a severely ill patient with eggshell distal aorta and femoro-iliac arteries undergoing coronary artery bypass grafting (CABG).


METHODS
Case report.


METHODS
An 18-bed adult cardiac surgery unit at a university hospital.


METHODS
A 68-yr-old man with ongoing unstable angina, left main disease, and eggshell calcification in the abdominal aorta and iliaco-femoral arteries, needing IABP for CABG.


METHODS
Percutaneous sheathless right transbrachial insertion of 7.5-Fr IABP, followed by CABG.


RESULTS
Fluoroscopy and chest radiograph were used to confirm the exact position of the IABP, in the preoperative and postoperative time, respectively. A digital pulse oximeter was applied to monitor distal perfusion. Anticoagulation consisted of nadroparin 4000 IU daily until the second postoperative day, followed by 150 mg of aspirin daily thereafter. Transbrachial IABP support allowed uneventful CABG and postoperative course, without IABP-related complications. Pulse oximetry demonstrated constant good values, the radial artery pulse was always present, and the hand appeared constantly warm. IABP was withdrawn 20 hrs following surgery, and the patient was discharged home on the ninth postoperative day.


CONCLUSIONS
The miniaturization of IABP, with the recent introduction of a 7.5-Fr balloon catheter, opens the door for the safe, effective transbrachial method of insertion in patients with severe peripheral atherosclerosis.
Onorati
Francesco
F
Cardiac Surgery Unit, Magna Graecia University, Catanzaro, Italy.
Bilotta
Massimo
M
Pezzo
Francesco
F
Impiombato
Barbara
B
Caroleo
Santo
S
Santangelo
Ermenegildo
E
Renzulli
Attilio
A
D000368:Aged; D001916:Brachial Artery; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery*; D005471:Fluoroscopy; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D010092:Oximetry; D011300:Preoperative Care; D011677:Punctures