Intra-Aortic Balloon Pump Rupture and Entrapment

Intra-aortic balloon pump is used frequently to support a failing myocardium in cardiac patients. Due to the invasive nature of this device, usage is accompanied by consistent risk of complications. Balloon rupture, although it occurs rarely, may lead to entrapment if diagnosis delays. A 78-year male who underwent cardiac surgery experienced balloon rupture and entrapment in the right femoral artery during the postoperative follow-up. Surgical extraction under local anesthesia was performed and the patient had an uneventful course. Fast and gentle solution of the problem is necessary to prevent further morbidity or mortality related to a retained balloon catheter in these delicate patients. 1. Introduction Intra-aortic balloon pump (IABP) counterpulsation is a very helpful tool in management of critic cardiac patients, both in cardiology and cardiovascular surgery units. It was first introduced by Kantrowitz et al. in 1967, and ever since its indications have significantly increased [1]. During decades, catheters have become easy to insert or extract, and the device itself can be simply controlled by even nonsenior health workers. However, despite all the technological progress that has been made, there is still a high rate of complications regarding IABP usage. Most of them include vascular complications such as limb ischemia, thromboembolism, visceral ischemia, and spinal cord injury [1]. Balloon rupture and entrapment are a rarely seen complication. There is limited literature regarding this topic, mostly in the form of case reports. We present a case where the balloon ruptured and was entrapped in femoral artery during extraction, which was solved surgically. 2. Case Report A 78-year old male, who had had a previously left internal mammarian artery (LIMA) and left anterior descending artery (LAD) bypass before 10 years, presented with angina pectoris and resting dyspnea. He also suffered from diabetes, obesity, and chronic obstructive lung disease. Echocardiography revealed dilated left heart chambers, ejection fraction of 30%, mild mitral regurgitation, and elevated pulmonary pressure. Coronary artery angiography demonstrated 80% stenosis of left main coronary artery, severe lesions of LAD and circumflex artery (Cx), total occlusion of LIMA, and noncritical lesions of right coronary artery. The patient underwent a double vessel off-pump coronary artery bypass grafting with saphenous grafts to LAD and Cx. Due to significant symptomatic status and poor coronary artery quality, preoperative IABP of 7.5？F and 40？cc size was inserted. Catheter was