title: In which patients should sheathless IABP be used? An analysis of vascular complications in 1211 cases.
abstract: OBJECTIVE
  The purpose of our study is to compare the results of the sheathed and sheathless techniques for intraaortic balloon pump (IABP) insertion and to determine the rate of vascular complications in both conditions.
  
  
  METHODS
  A total of 1211 patients were examined representing a period of 19 years. Three hundred five sheathless (Group I) and 906 sheathed (Group II) IABP catheters were evaluated retrospectively. Data were analyzed with univariate analysis and logistic regression. Relative risk (RR) values were calculated in order to examine the effect of sheath.
  
  
  RESULTS
  Limb ischemia was seen in 129 patients (10.9%). Although the incidence of peripheral arterial disease (PAD) was relatively higher in Group I (11.1% vs. 3.6%), the ischemic complication rate was lower in Group I (5.2% vs. 12.4%; p = 0.001). Presence of PAD (p = 0.001) and diabetes mellitus (DM) (p = 0.007) was found to be the risk factors of ischemia related to IABP use in all cases. In logistic regression analysis, presence of PAD, DM, and sheathed method was found to be the risk factors of ischemia. The patients who had all of these risk factors suffered from limb ischemia (RR value: 35.17).
  
  
  CONCLUSIONS
  PAD, DM, and sheathed insertion technique are the major risk factors of ischemia during IABP use. Among all these risk factors, the only modifiable risk factor is the use of introducer sheath. With the presence of PAD and DM, the choice of sheathed method would increase the probability of ischemia almost 35 times. Sheathless method of insertion should be preferred in patients with DM and PAD.
authors.affiliation: Department of Cardiovascular Surgery, Kosuyolu Heart and Research Hospital, 34865 Kartal, Istanbul, Turkey.
authors.forename: Hasan Basri
authors.initials: HB
authors.lastname: Erdogan
authors.forename: Deniz
authors.initials: D
authors.lastname: Goksedef
authors.forename: Vedat
authors.initials: V
authors.lastname: Erentug
authors.forename: Adil
authors.initials: A
authors.lastname: Polat
authors.forename: Nilgün
authors.initials: N
authors.lastname: Bozbuga
authors.forename: Denyan
authors.initials: D
authors.lastname: Mansuroglu
authors.forename: Mustafa
authors.initials: M
authors.lastname: Guler
authors.forename: Esat
authors.initials: E
authors.lastname: Akinci
authors.forename: Cevat
authors.initials: C
authors.lastname: Yakut
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002408:Catheters, Indwelling; D004867:Equipment Design; D004869:Equipment Safety; D005121:Extremities / Q000098:blood supply*; D005260:Female; D006333:Heart Failure / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects / Q000295:instrumentation; D007511:Ischemia / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome