Limb salvage following iatrogenic arterial injury: complications of cardiac support using intra-aortic balloon pumps.
This is a unique case report describing complex limb salvage in a patient who experienced acute limb ischaemia due to a complication of intra-aortic balloon pump (IABP) counterpulsation. This case focuses on a patient who had an IABP counterpulsation device inserted following myocardial infarction, requiring urgent coronary artery bypass grafting for acute coronary syndrome. Postoperatively, the IABP could not be removed, with consequent iliac thrombosis and acute limb ischaemia. Emergency femoral-to-femoral crossover bypass was performed using a polytetrafluoroethylene graft. A portion of the IABP balloon tip was entrapped and retained, however, and became the focus of delayed septicaemia, resulting in graft infection and wound breakdown 6 weeks later. Explantation of the residual balloon tip, ligation of the right external iliac artery and redo femoral-femoral crossover using the great saphenous vein were successfully performed.
Department of Vascular Surgery, Kings College Hospital, London, UK.
Adam
http://orcid.org/0000-0002-5043-9949
A
Hunt
Department of Vascular Surgery, Kings College Hospital, London, UK.
Owen
O
Waldin
Department of Vascular Surgery, Kings College Hospital, London, UK.
Hani
H
Slim
Department of Vascular Surgery, Kings College Hospital, London, UK.
Ranjeet
R
Brar
D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods; D020878:Device Removal / Q000009:adverse effects; D006801:Humans; D007049:Iatrogenic Disease; D007083:Iliac Artery / Q000293:injuries*; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects*; D023821:Limb Salvage; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy; D011183:Postoperative Complications / Q000601:surgery*; D013514:Surgical Procedures, Operative