Access from the femoral arteries to the thoracic aorta for intra-aortic balloon pump (IABP) insertion may not be feasible in a substantial number of patients with severe peripheral vascular disease. Since using an alternative access is inevitable in a certain number of patients requiring IABP support, all alternative accesses should be added to the surgical armamentarium. Herein, we present our 27-year experience with different alternative accesses for IABP insertion following failed contraindication to femoral artery cannulation. The alternative techniques described below were: transthoracic insertion with a tube graft, transthoracic insertion – direct, transaxillary/subclavian insertion and transbrachial insertion.
KantrowitzATjonnelandSFreedPSPhillipsSJButnerANShermanJLJr.Initial clinical experience with Intraaortic balloon pumping in cardiogenic shock. JAMA1968; 203: 113–118.
2.
FergusonJJ3rdCohenMFreedmanRJJr. The current practice of intra-aortic balloon counterpulsation: results from the Benchmark Registry. J Am Coll Cardiol2001; 38: 1456–1462.
3.
HazelriggSRAuerJESeifertPE. Experience in 100 transthoracic balloon pumps. Ann Thorac Surg1992; 54: 528–532.
4.
ZatteraGTotaroPD’ArminiAMViganòM. Intra aortic balloon pump insertion through left axillary artery in patients with severe peripheral arterial disease. Interact Thorac Cardiovaasc Surg2009; 9: 369–370.
5.
RamanJLoorGLondonMJollyN. Subclavian artery access for ambulatory balloon pump insertion. Ann Thorac Surg2010; 90: 1032–1034.
6.
OnoratiFImpiombatoBFerraroA. Transbrachial intraaortic balloon pumping in severe peripheral atherosclerosis. Ann Thorac Surg2007; 84: 264–266.
7.
NoelBMGleetonOBarbeauGR. Transbrachial insertion of an intraaortic balloon pump for complex coronary angioplasty. Catheter Cardiovasc Intervent2003; 60: 36–39.
8.
ThieleHZeymerUNeumannFJ. Intraaortic balloon pump in cardiogenic shock II (IABP-SHOCK II) trial investigators. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet2013; 382: 1638–1645.
9.
SantarpinoGOnoratiFRubinoAS. Preoperative intraaortic balloon pumping improves outcomes for high-risk patients in routine coronary artery bypass graft surgery. Ann Thorac Surg2009; 87: 481–488.
10.
ParissisHSooAAl-AlaoB. Intra aortic balloon pump: literature review of risk factors related to complications of the intraaortic balloon pump. J Cardiothorac Surg2011; 6: 147–152.
11.
McGeehinWSheikhFDonahooJSLechmanMJMacVaughH3rd. Transthoracic intraaortic balloon pump support: experience in 39 patients. Ann Thorac Surg1987; 44: 26–30.
12.
KaplanLJWeimanDSLanganNSokilABWhitmanGJ. Safe intraaortic balloon pump placement through the ascending aorta using transesophageal ultrasound. Ann Thorac Surg1992; 54: 374–375.
13.
UgorjiCCTurnerSAMcGeeMGFuhrmanTMCooleyDANormanJC. Transascending aortic intraaortic balloon insertion with delayed sternal closure: a retrospective analysis. Cardiovasc Dis1980; 7: 307–315.
14.
BonchekLIOlingerGN. Direct ascending aortic insertion of the ‘‘percutaneous’’ intraaortic balloon catheter in the open chest: advantages and precautions. Ann Thorac Surg1981; 32: 512–514.
15.
BaciewiczFAJrKaplanBMMurphyTENeimanHL. Bilateral renal artery thrombotic occlusion: a unique complication following removal of a transthoracic intraaortic balloon. Ann Thorac Surg1982; 33: 631–634.
16.
Meldrum-HannaWGDealCWRossDE. Complications of ascending aortic intraaortic balloon pump cannulation. Ann Thorac Surg1985; 40: 241–244.
17.
CochranRPStarkeyTDPanosALKunzelmanKS. Ambulatory intraaortic balloon pump use as bridge to heart transplant. Ann Thorac Surg2002; 74: 746–751.
18.
MarcuCBDonohueTJFerneiniAGhantousAE. Intraaortic balloon pump insertion through the subclavian artery. Subclavian artery insertion of IABP. Heart Lung Circ2006; 15: 148–150.
