Limb salvage following iatrogenic arterial injury: complications of cardiac support using intra-aortic balloon pumps

Abstract

This is a unique case report describing complex limb salvage in a patient who experienced acute limb ischaemia due to a complication of intra-aortic balloon pump (IABP) counterpulsation. This case focuses on a patient who had an IABP counterpulsation device inserted following myocardial infarction, requiring urgent coronary artery bypass grafting for acute coronary syndrome. Postoperatively, the IABP could not be removed, with consequent iliac thrombosis and acute limb ischaemia. Emergency femoral-to-femoral crossover bypass was performed using a polytetrafluoroethylene graft. A portion of the IABP balloon tip was entrapped and retained, however, and became the focus of delayed septicaemia, resulting in graft infection and wound breakdown 6 weeks later. Explantation of the residual balloon tip, ligation of the right external iliac artery and redo femoral-femoral crossover using the great saphenous vein were successfully performed.

Figure 1

Horizontal CT section demonstrating thrombosed right iliac system with indwelling IABP device (arrow) IABP, intra-aortic balloon pump.

Figure 2

Horizontal CT section of same patient following graft infection suppurating to right groin (arrow 1) with femoral-femoral PTFE graft in situ (arrow 2). PTFE, polytetrafluoroethylene graft.