Visceral arterial compromise during intra-aortic balloon counterpulsation therapy

Ardawan Julian Rastan, Eugen Tillmann, Sreekumar - Subramanian, Lukas Lehmkuhl, Anne Kathrin Funkat, Sergej Leontyev, Torsten Doenst, Thomas Walther, Matthias Gutberlet, Friedrich Wilhelm Mohr

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Background-: Intraaortic balloon pump (IABP) therapy is a widely used method of circulatory support. Based on frequent findings of balloon malposition with visceral arterial compromise on computerized tomographic (CT) imaging studies, we conducted a systematic review of cardiac surgical IABP patients with available CT scans to determine reasons, incidence, and clinical relevance of malposition. Methods and results-: From January 2007 to March 2009, a total of 621 of 7756 cardiac surgical patients (8.0%) received perioperative IABP support, of whom 63 (10.1%) received a thoracoabdominal CT scan during IABP support. Proximal and distal balloon positions were analyzed. The anatomic distance from the left subclavian artery to celiac trunk and aortic transverse diameter were measured in all patients and compared with implanted balloon dimensions. Mean age was 67.1±11.9 years; 33.3% were female, and height was 169±9 cm. Based on radiography, proximal balloon position was correct in 96.8% but only appropriate in 38.1% based on CT. In 61 of 63 patients, compromise of at least 1 visceral artery was found: celiac trunk, 96.8%; superior mesenteric artery, 87.3%; and renal arteries, 66.7%. Left subclavian artery to celiac trunk distance was 241±23 mm, and balloon length was 248±17 mm and corresponded to an anatomic to balloon length mismatch in 68.2%. Spinal deformations were found in 42.9%. Laparotomy for mesenteric ischemia was required in 23.8%. Hospital mortality rate was 60.3%. Conclusions-: IABP malposition was commonly identified by CT. Reasons included incorrect proximal balloon position as well as an anatomic-to-balloon length mismatch. Thus, shorter than recommended balloon sizes and better positioning strategies had to be considered.

Original languageEnglish (US)
JournalCirculation
Volume122
Issue number11 SUPPL. 1
DOIs
StatePublished - Sep 14 2010
Externally publishedYes

Fingerprint

Counterpulsation
Abdomen
Subclavian Artery
Superior Mesenteric Artery
Renal Artery
Therapeutics
Hospital Mortality
Radiography
Laparotomy
Arteries
Mortality
Incidence

Keywords

  • balloon size
  • IABP
  • renal artery
  • visceral artery
  • visceral ischemia

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Rastan, A. J., Tillmann, E., Subramanian, S. ., Lehmkuhl, L., Funkat, A. K., Leontyev, S., ... Mohr, F. W. (2010). Visceral arterial compromise during intra-aortic balloon counterpulsation therapy. Circulation, 122(11 SUPPL. 1). https://doi.org/10.1161/CIRCULATIONAHA.109.929810

Visceral arterial compromise during intra-aortic balloon counterpulsation therapy. / Rastan, Ardawan Julian; Tillmann, Eugen; Subramanian, Sreekumar -; Lehmkuhl, Lukas; Funkat, Anne Kathrin; Leontyev, Sergej; Doenst, Torsten; Walther, Thomas; Gutberlet, Matthias; Mohr, Friedrich Wilhelm.

In: Circulation, Vol. 122, No. 11 SUPPL. 1, 14.09.2010.

Research output: Contribution to journalArticle

Rastan, AJ, Tillmann, E, Subramanian, S, Lehmkuhl, L, Funkat, AK, Leontyev, S, Doenst, T, Walther, T, Gutberlet, M & Mohr, FW 2010, 'Visceral arterial compromise during intra-aortic balloon counterpulsation therapy', Circulation, vol. 122, no. 11 SUPPL. 1. https://doi.org/10.1161/CIRCULATIONAHA.109.929810
Rastan, Ardawan Julian ; Tillmann, Eugen ; Subramanian, Sreekumar - ; Lehmkuhl, Lukas ; Funkat, Anne Kathrin ; Leontyev, Sergej ; Doenst, Torsten ; Walther, Thomas ; Gutberlet, Matthias ; Mohr, Friedrich Wilhelm. / Visceral arterial compromise during intra-aortic balloon counterpulsation therapy. In: Circulation. 2010 ; Vol. 122, No. 11 SUPPL. 1.
@article{908a7548c5b546808afb1107aa255e27,
title = "Visceral arterial compromise during intra-aortic balloon counterpulsation therapy",
abstract = "Background-: Intraaortic balloon pump (IABP) therapy is a widely used method of circulatory support. Based on frequent findings of balloon malposition with visceral arterial compromise on computerized tomographic (CT) imaging studies, we conducted a systematic review of cardiac surgical IABP patients with available CT scans to determine reasons, incidence, and clinical relevance of malposition. Methods and results-: From January 2007 to March 2009, a total of 621 of 7756 cardiac surgical patients (8.0{\%}) received perioperative IABP support, of whom 63 (10.1{\%}) received a thoracoabdominal CT scan during IABP support. Proximal and distal balloon positions were analyzed. The anatomic distance from the left subclavian artery to celiac trunk and aortic transverse diameter were measured in all patients and compared with implanted balloon dimensions. Mean age was 67.1±11.9 years; 33.3{\%} were female, and height was 169±9 cm. Based on radiography, proximal balloon position was correct in 96.8{\%} but only appropriate in 38.1{\%} based on CT. In 61 of 63 patients, compromise of at least 1 visceral artery was found: celiac trunk, 96.8{\%}; superior mesenteric artery, 87.3{\%}; and renal arteries, 66.7{\%}. Left subclavian artery to celiac trunk distance was 241±23 mm, and balloon length was 248±17 mm and corresponded to an anatomic to balloon length mismatch in 68.2{\%}. Spinal deformations were found in 42.9{\%}. Laparotomy for mesenteric ischemia was required in 23.8{\%}. Hospital mortality rate was 60.3{\%}. Conclusions-: IABP malposition was commonly identified by CT. Reasons included incorrect proximal balloon position as well as an anatomic-to-balloon length mismatch. Thus, shorter than recommended balloon sizes and better positioning strategies had to be considered.",
keywords = "balloon size, IABP, renal artery, visceral artery, visceral ischemia",
author = "Rastan, {Ardawan Julian} and Eugen Tillmann and Subramanian, {Sreekumar -} and Lukas Lehmkuhl and Funkat, {Anne Kathrin} and Sergej Leontyev and Torsten Doenst and Thomas Walther and Matthias Gutberlet and Mohr, {Friedrich Wilhelm}",
year = "2010",
month = "9",
day = "14",
doi = "10.1161/CIRCULATIONAHA.109.929810",
language = "English (US)",
volume = "122",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "11 SUPPL. 1",

}

TY - JOUR

T1 - Visceral arterial compromise during intra-aortic balloon counterpulsation therapy

AU - Rastan, Ardawan Julian

AU - Tillmann, Eugen

AU - Subramanian, Sreekumar -

AU - Lehmkuhl, Lukas

AU - Funkat, Anne Kathrin

AU - Leontyev, Sergej

AU - Doenst, Torsten

AU - Walther, Thomas

AU - Gutberlet, Matthias

AU - Mohr, Friedrich Wilhelm

PY - 2010/9/14

Y1 - 2010/9/14

N2 - Background-: Intraaortic balloon pump (IABP) therapy is a widely used method of circulatory support. Based on frequent findings of balloon malposition with visceral arterial compromise on computerized tomographic (CT) imaging studies, we conducted a systematic review of cardiac surgical IABP patients with available CT scans to determine reasons, incidence, and clinical relevance of malposition. Methods and results-: From January 2007 to March 2009, a total of 621 of 7756 cardiac surgical patients (8.0%) received perioperative IABP support, of whom 63 (10.1%) received a thoracoabdominal CT scan during IABP support. Proximal and distal balloon positions were analyzed. The anatomic distance from the left subclavian artery to celiac trunk and aortic transverse diameter were measured in all patients and compared with implanted balloon dimensions. Mean age was 67.1±11.9 years; 33.3% were female, and height was 169±9 cm. Based on radiography, proximal balloon position was correct in 96.8% but only appropriate in 38.1% based on CT. In 61 of 63 patients, compromise of at least 1 visceral artery was found: celiac trunk, 96.8%; superior mesenteric artery, 87.3%; and renal arteries, 66.7%. Left subclavian artery to celiac trunk distance was 241±23 mm, and balloon length was 248±17 mm and corresponded to an anatomic to balloon length mismatch in 68.2%. Spinal deformations were found in 42.9%. Laparotomy for mesenteric ischemia was required in 23.8%. Hospital mortality rate was 60.3%. Conclusions-: IABP malposition was commonly identified by CT. Reasons included incorrect proximal balloon position as well as an anatomic-to-balloon length mismatch. Thus, shorter than recommended balloon sizes and better positioning strategies had to be considered.

AB - Background-: Intraaortic balloon pump (IABP) therapy is a widely used method of circulatory support. Based on frequent findings of balloon malposition with visceral arterial compromise on computerized tomographic (CT) imaging studies, we conducted a systematic review of cardiac surgical IABP patients with available CT scans to determine reasons, incidence, and clinical relevance of malposition. Methods and results-: From January 2007 to March 2009, a total of 621 of 7756 cardiac surgical patients (8.0%) received perioperative IABP support, of whom 63 (10.1%) received a thoracoabdominal CT scan during IABP support. Proximal and distal balloon positions were analyzed. The anatomic distance from the left subclavian artery to celiac trunk and aortic transverse diameter were measured in all patients and compared with implanted balloon dimensions. Mean age was 67.1±11.9 years; 33.3% were female, and height was 169±9 cm. Based on radiography, proximal balloon position was correct in 96.8% but only appropriate in 38.1% based on CT. In 61 of 63 patients, compromise of at least 1 visceral artery was found: celiac trunk, 96.8%; superior mesenteric artery, 87.3%; and renal arteries, 66.7%. Left subclavian artery to celiac trunk distance was 241±23 mm, and balloon length was 248±17 mm and corresponded to an anatomic to balloon length mismatch in 68.2%. Spinal deformations were found in 42.9%. Laparotomy for mesenteric ischemia was required in 23.8%. Hospital mortality rate was 60.3%. Conclusions-: IABP malposition was commonly identified by CT. Reasons included incorrect proximal balloon position as well as an anatomic-to-balloon length mismatch. Thus, shorter than recommended balloon sizes and better positioning strategies had to be considered.

KW - balloon size

KW - IABP

KW - renal artery

KW - visceral artery

KW - visceral ischemia

UR - http://www.scopus.com/inward/record.url?scp=77957225459&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77957225459&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.109.929810

DO - 10.1161/CIRCULATIONAHA.109.929810

M3 - Article

C2 - 20837932

AN - SCOPUS:77957225459

VL - 122

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 11 SUPPL. 1

ER -