title: Transbrachial insertion of a 7.5-Fr intra-aortic balloon pump in a severely atherosclerotic patient.
abstract: 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 IABP was withdrawn 20 hrs following surgery, and the patient was discharged home on the ninth postoperative day.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.
authors.affiliation: Cardiac Surgery Unit, Magna Graecia University, Catanzaro, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
authors.forename: Massimo
authors.initials: M
authors.lastname: Bilotta
authors.forename: Francesco
authors.initials: F
authors.lastname: Pezzo
authors.forename: Barbara
authors.initials: B
authors.lastname: Impiombato
authors.forename: Santo
authors.initials: S
authors.lastname: Caroleo
authors.forename: Ermenegildo
authors.initials: E
authors.lastname: Santangelo
authors.forename: Attilio
authors.initials: A
authors.lastname: Renzulli
mesh_terms: 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