Issue |
J Extra Corpor Technol
Volume 45, Number 1, March 2013
|
|
---|---|---|
Page(s) | 51 - 54 | |
DOI | https://doi.org/10.1051/ject/201345051 | |
Published online | 15 March 2013 |
Case Reports
Anatomical Advantage to Percutaneous Insertion of the Intra-Aortic Balloon through the Left Brachial Artery over the Right Brachial Artery
* Department of Perfusion Services, Southlake Regional Health Centre, Newmarket, Ontario, Canada
† Cardiology & Associates, Southlake Regional Health Centre Newmarket, Ontario, Canada
Address correspondence to: Bharat Datt, MSc, CCP, CPC, Clinical Perfusionist, Mazankowski Alberta Heart Institute and Stollery Children’s Hospital, University of Alberta, 8440 112 Street, Edmonton, Alberta, T6G 2B7, Canada. E-mail: canuckpumpman@gmail.com
Received:
11
May
2012
Accepted:
6
February
2013
Off-label use of the intra-aortic balloon (IAB) is not recommended in ideal situations and certainly not a Food and Drug Administration-approved activity. The instruction-for-use manual for the IAB recommends percutaneous insertion. However, there are certain extreme situations where “thinking outside the box” appears necessary. We have successfully inserted a transthoracic IAB (TIAB) in the operating room where an open sternum is an option. This has been instituted whenever severe peripheral vascular disease (PVD) precludes a percutaneous attempt or when attempted insertion fails. An open chest is not a choice in the catheterization laboratory or the postoperative setting. We have successfully inserted the IAB through the brachial/axillary artery in a patient with bilateral aortofemoral grafts, with a history of severe PVD, in the cardiac catheterization laboratory. A left-sided approach is advisable for brachial artery insertion and an axillary approach is also possible under sedation. This case report details our experience with transbrachial insertion of the IAB and establishes counterpulsation through this route as a viable option, where an open chest is not available and a percutaneous femoral approach has failed.
Key words: transthoracic / transbrachial / peripheral vascular disease / intra-aortic balloon / counterpulsation
© 2013 AMSECT
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