Radiological imaging of the Intra-Aortic Balloon Pump; positioning and associated complications.

Congress:

ECR 2018

Poster Number:

C-0028

Type:

Educational Exhibit

Keywords:

Obstruction / Occlusion, Haemodynamics / Flow dynamics, Cardiac Assist Devices, Instrumentation, Education, Complications, CT, Conventional radiography, Interventional vascular, Cardiovascular system, Arteries / Aorta

Authors:

B. Gibney¹, J. Ryan¹, A. N. Murphy¹, C. D. Gillespie ², C. A. Ridge¹; ¹Dublin/IE, ²Dublin 7/IE

DOI:

10.1594/ecr2018/C-0028

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-0028

Fig. 5: Sagittal CT aortic angiogram demonstrating left external iliac artery...

Fig. 6: Axial CT lower limb angiogram demonstrating a pseudoaneurysm (arrowhead)...

Fig. 7: Axial CT abdomen demonstrating IABP below origin of the SMA with bowel...

Fig. 9: CT Brain after acute onset left sided weakness in a patient receiving IABP...

Learning objectives

To provide an educational and pictorial review of the imaging manifestations of anatomical and positioning considerations and complications of aortic counter-pulsation therapy using an intra-aortic balloon pump (IABP). To illustrate and describe radiology’s role in guiding size and position of IABP and in diagnosis of complications related to the insertion and presence of the device.

Background

Aortic counter-pulsation therapy using an intra-aortic balloon pump (IAPB) is the most commonly used mechanical circulatory assistance for a range of causes of compromised cardiac output [1]. The IABP is an elongated balloon mounted on an 8 Fr catheter placed in the descending aorta, most commonly via the femoral artery. It functions by inflating in diastole which increases flow to the coronary arteries and then rapid deflation immediately presystole reduces left ventricular (LV) afterload and LV myocardial oxygen requirement. Furthermore, it increases cardiac output and...

Findings and procedure details

Complications in the setting of IABP therapy may relate to direct complications from balloon insertion, positioning, malfunctioning or removal, or they may relate to the underlying cardiovascular compromise for which the use of counter-pulsation therapy was required. This can include myocardial infarction, pulmonary oedema and acute kidney injury. The presence of peripheral arterial disease has been the most consistent and reproducible predictor of complications [4,5,6]. In a large multinational registry, 7% of 16,909 IABP recipients experienced IABP-related complication. Of these, 2.6% had major complications, including...

Conclusion

IABP is the most commonly used mechanical cardiac assist device. Knowledge of correct positioning and the common and serious complications of IABP therapy are crucial for the radiologist interpreting scans in patients with IABP in situ or recent IABP therapy.

Personal information

Thank you for reading my poster. If you have any questions please contact me at [email protected].

References

Trost JC, Hillis LD. Intra-aortic balloon counterpulsation. Am J Cardiol. 2006 May 1;97(9):1391-8. Epub 2006 Mar 20. Review. PubMed PMID: 16635618. Nagpal A.D., Singal R.K., Arora R.C., Lamarche Y. Temporary Mechanical Circulatory Support in Cardiac Critical Care: A State of the Art Review and Algorithm for Device Selection (2017) Canadian Journal of Cardiology, 33 (1) , pp. 110-118 Kim JT, Lee JR, Kim JK et al. The carina as a useful radiographic landmark for positioning the intraaortic balloon pump. Anesth Analg. 2007 Sep;105(3):735-8. PubMed PMID:...