Reduction in ischemic vascular complications with a hydrophilic-coated intra-aortic balloon catheter

Hydrophilic coatings improve the handling characteristics of angioplasty equipment, but until recently this technology has not been available for intra-aortic balloon (IAB) catheters. To determine whether a new hydrophilic coating is associated with a reduction in IAB-related complications, we prospectively evaluated 188 patients undergoing insertion of this new IAB catheter. Complications related to IAB insertion were recorded and compared to data from 682 patients previously treated with an uncoated IAB catheter of the same shaft diameter and balloon size. By multivariate analysis the hydrophilic-coated IAB catheter was associated with a 72% reduction in ischemic vascular complications (relative risk 0.28, 95% CI 0.08–0.96, P = 0.04). There were also trends toward reductions in IAB rupture and the need for vascular surgical repair for bleeding or ischemia. While further investigation is warranted, hydrophilic coatings that reduce the coefficient of friction during IAB catheter insertion may also reduce subsequent ischemic vascular complications. Cathet. Cardiovasc. Intervent. 46:357–362, 1999. © 1999 Wiley-Liss, Inc.     

Use of a modified angioplasty balloon catheter in the dilatation of tight biliary strictures.

Nineteen biliary strictures were dilated using a modified angioplasty balloon catheter to allow insertion of a 10F prosthesis. In each instance biliary strictures were successfully dilated which had previously been too tight to widen with standard endoscopic biliary dilating catheters. Eleven patients had malignant hilar strictures, four malignant distal common bile duct strictures, and four benign strictures. There were no complications as a result of the procedure and satisfactory biliary drainage was established in all patients. We conclude that tight biliary strictures can be successfully dilated using a modified angioplasty balloon catheter.     

Endoscopic balloon dilation of postoperative duodenal stricture by using a new type of wire‐guided balloon catheter

When the stricture of gastrointestinal tract is complicated, the insertion of the balloon catheter is very difficult even with ‘through‐the‐scope’ balloon dilators. We present here a new type of multifunctional balloon dilator, controlled radial expansion (CRE) wire‐guided balloon dilatation catheter (Boston Scientific, MA, USA). This instrument enabled successful treatment of a complicated postoperative stricture of the duodenum. A 74‐year‐old man, who had undergone duodenum‐preserving resection of the head of the pancreas for mucin‐producing tumor, had severe stenosis at the duodenal second portion. After failed trials in negotiating the stricture by means of conventional balloon dilators, CRE wire‐guided balloon dilatation catheter was introduced through the working channel of the scope and advanced over a guide wire into the stricture under fluoroscopic control. The stenosis was successfully dilated up to the full size of the balloon (20 mm) by increasing the inflation pressure in a stepwise manner. After the procedure, the patient could consume soft food and gruel easily without complications. The dilation effect has been maintained up to the present for more than 12 months. This new instrument is recommended in endoscopic dilation as a safe and useful tool, even for a complicated stricture.     

Vascular complications associated with the use of intraaortic balloon pumping

Our 11-year experience with intraaortic balloon pumping (IABP) was analyzed to determine the incidence and evaluate the management of vascular complications. Between 1973 and 1984, 637 patients were candidates for IABP. In 41 cases, IABP was precluded because peripheral vascular disease inhibited balloon catheter insertion. Of the 596 patients who underwent IABP, 304 (51.0%) survived the hospital period, and late follow-up information was available for 283 (93%) of these. The late results were analyzed with respect to the duration of survival and the presence of lower-extremity claudication. Sixty-six (11.1%) of the 596 patients experienced vascular complications (mainly in the form of limb ischemia). Balloon removal, followed by thromboembolectomy, restored limb viability in the majority of cases. When continued IABP was required, creation of a femoral-femoral bypass to the portion of the limb distal to the balloon allowed viability to be maintained.     

Pulmonary artery catheter-induced hemorrhage

Pulmonary artery rupture by a flow-directed balloon-tipped catheter is a rare complication if guidelines for insertion of catheters are strictly applied. It should be stressed that the need for a "confirmed" wedge pressure should be weighed against the very real risk of this potentially fatal complication. Users of this catheter should expect and anticipate distal migration of the catheter tip. Great care must be exercised in inflating the balloon, particularly when the location of the catheter tip in the pulmonary vascular bed is unknown. Excessive catheter manipulation should be avoided. Hemoptysis, hemothorax, cardiac or respiratory instability in patients who have the PA catheter should be suspected to have this grave complication and appropriate emergency measures should be taken until this complication has been ruled out.     

Percutaneous intraaortic balloon insertion

A new single chambered percutaneous intraaortic balloon has been constructed around a central guidewire. The balloon can be wrapped around the guidewire, enabling its insertion into the femoral artery through a 12F sheath inserted with the conventional Seldinger technique. Percutaneous intraaortic balloon insertion has been performed in 27 patients (mean age 58 years) for a variety of medical and surgical indications. Percutaneous balloons could not be advanced into the aorta in two patients (7.4 percent) with severe bilateral aortoillac occlusive disease. In all 25 patients undergoing intraaortic balloon pumping satisfactory circulatory support was achieved, and 21 (84 percent) of the patients survived to be discharged from the hospital. The mean duration of intraaortic balloon pumping was 3.5 days.Percutaneous intraaortic balloon insertion requires less than 5 minutes and has been successfully performed in the cardiac catheterization laboratory, coronary care unit, operating room and recovery room. After direct balloon removal, external pressure was applied for 30 minutes. No patient experienced hematoma of the groin, aortic dissection, compromised distal pulses or late wound complications. Percutaneous balloon insertion permits the rapid institution of circulatory support and broadens the medical and surgical applications of intraaortic balloon pumping.     

Percutaneous wire-guided balloon pumping

A percutaneous wire-guided double lumen intraaortic balloon pump was tested in 44 patients, 15 with cardiogenic shock. The balloon volume is 40 ml, the material is Avcothane, and the central lumen will pass a 0.035 inch (0.889 mm) wire guide. Standard Seldinger technique was followed by successful insertion in 40 patients (90 percent) with no recognized vascular trauma. Counterpulsation was excellent and central pressure monitoring through the balloon lumen showed good fidelity. Iliofemoral thrombosis occurred in 5 percent of patients. The overguide technique is simple, successful and atraumatic.     

The Novel 4.5F CoKatte Catheter for Stent Delivery Facilitation in Complex Coronary Artery Lesions

BackgroundThe mother and child technique with a deep-seated 4F Kiwami catheter has been reported to be effective for delivering stents to complex lesions.ObjectivesTo assess the feasibility and efficacy of a novel 4.5F child catheter for deep insertion and stent deployment into the distal coronary artery for the treatment of complex lesions.MethodWe retrospectively evaluated 51 consecutive patients, who underwent percutaneous coronary intervention between January 2011 and December 2013, using a 4.5F CoKatte catheter after stent delivery failure using the conventional procedures. We evaluated the procedure success, need for an additional anchor balloon technique, and complications related to the deep insertion.ResultsStent delivery to the intended lesion was successful in all cases. For advancement and subsequent deep intubation of the catheter, 42 lesions required the additional anchor balloon technique. No complications, including proximal dissection, air embolism, and severe ischemia, were observed in relation to the deep insertion of the catheter.ConclusionPercutaneous coronary intervention with the novel 4.5F catheter is a safe and effective method, which can facilitate stent delivery to a complex coronary lesion.     

Cholangiography of intrahepatic bile ducts in hepatolithiasis by endoscopic placement of an indwelling balloon catheter

To improve the diagnostic yield and safety of endoscopic retrograde balloon catheter cholangiography, two technical refinements were added: (1) intraductal retention of a balloon catheter allowing injection of a contrast medium in the supine position; and (2) slow, constant injection of the contrast medium with a heavy-duty infusion pump. Maximum filling of intrahepatic branches was attempted by both the original balloon method and the new method in seven hepatolithiasis patients. The new method was superior for visualization of the right intrahepatic ducts. Although there were no significant differences in the amount of filling of the left intrahepatic ducts, the new method provided an unobstructed view since the endoscope was out of the way. Harmful rapid increase of intraductal pressure and excessive injection of contrast medium were avoided by fluoroscopically controlled infusion. No serious complications were encountered.     

Retrograde nontransseptal balloon mitral valvuloplasty using a modified inoue balloon catheter

Retrograde nontransseptal balloon mitral valvuloplasty, a method developed in our institution for the treatment of symptomatic mitral stenosis, avoids transseptal catheterization. Until recently, the self-positioning Inoue balloon catheter, unlike all other commercially available balloon catheters, had not been employed in this nontransseptal technique due to the short length of its catheter shaft. To employ a self-positioning balloon in retrograde nontransseptal balloon mitral valvuloplasty, we modified the Inoue device by extension of the catheter shaft. After retrograde nontransseptal left atrial catheterization using a steerable cardiac catheter, the modified Inoue balloon catheter was inserted through the femoral artery and advanced to the mitral valve retrogradely. Valvuloplasty was performed in 20 patients, with a successful result achieved in all. The modified Inoue balloon catheter was easy to use in retrograde nontransseptal balloon mitral valvuioplasty and showed excellent stability during inflation. Mean mitral valve area increased from 1.0 ± 0.29 to 2.23 ± 0.64 cm² (P<0.001) and mean transmitral gradient decreased from 11.4 ± 6 to 4.3 ± 2.1 mm Hg (P<0.001). No major or minor complications were observed. Retrograde nontransseptal balloon mitral valvuloplasty using a modified Inoue balloon catheter is a feasible and effective technique for the treatment of symtomatic mitral stenosis. It appears to combine the advantages of avoiding transseptal catheterization with the advantages of this balloon's special configuration. © Wiley-Liss, Inc.     

Transesophageal echocardiographic monitoring of interventional cardiac catheterization in children

Transesophageal echocardiography was used prospectively in 22 children scheduled for interventional cardiac catheterization (9 with pulmonary valvuloplasty, 5 with aortic valvuloplasty, 1 with pulmonary angioplasty, 2 with aortic angioplasty, 2 with patent ductus arteriosus occlusion and 3 with Mustard baffle dilation) to determine its potential value as a monitoring technique. The patients ranged in age from 0.9 to 14.6 years (mean 5.4) and in weight from 9.5 to 49.2 kg (mean 21.1). Studies were completed in all patients without complications. Preintervention studies provided important new information in two patients, leading to cancellation of the planned procedure. Major contributions of transesophageal monitoring included 1) a real time assessment of catheter placement across either atrioventricular valve and the aortic valve during balloon valvuloplasty; 2) immediate assessment of aortic valve and aortic wall morphology during balloon dilation; and 3) detailed morphologic and hemodynamic information together with enhanced catheter guidance during Mustard baffle dilation. After pulmonary valvuloplasty, partial chordal rupture of the tricuspid valve was documented in one patient. In two patients, balloon catheter position was modified according to the transesophageal findings. The assessment of changes in pulmonary valve morphology and transcatheter occlusion of a patent ductus arteriosus was not enhanced by single-plane transesophageal monitoring. Pulsed wave Doppler studies contributed additional information in the assessment of immediate hemodynamic changes after interventional procedures. Transesophageal echocardiography is a new important guiding and monitoring technique during interventional cardiac catheterization procedures in children. It can provide additional real time imaging information, immediate identification of complications and assessment of hemodynamic changes.     

Postoperative nursing and prevention of complications in patients receiving coronary artery bypass grafting with the application of Swan-Ganz balloon floating catheter

Background The patients having received CABG are more likely to suffer from cardiac dysfunction and hemodynamic instability. Floating catheter provides a full set of hemodynamic parameters in an accurate manner.Methods From January 6,2018,to December 29,2018,101 patients receiving CABG in our department were selected. Among them,53 patients indwelt with Swan-Ganz balloon floating catheters. The correct application of indwelling Swan-Ganz balloon floating catheter was analyzed targeting 53 patients receiving CABG to standardize nursing and prevent complications. Results Of the 53 patients recruited,48 cases recovered,3 cases had clinical death,and 2 cases were automatically discharged. There are 16 cases subject to complications and adverse reactions. In 4 cases with catheter obstruction in SICU where CVP could be measured,floating catheters were removed in time within 24 hours after catheterization in 3 cases and 1 d22 h in 1 case. In 2 cases,catheter obstruction happened in SICU after CO measurement and before CVP measurement,where catheter obstruction was observed 1 d8 h after catheterization,and floating catheters were removed within 2 d22 h in all cases. There were 3 cases who had capillary hemorrhage at puncture sites,where compression hemostasis with cigarette coils and gauze blocks was performed in all cases,followed by 3 M TegadermTMtransparent film dressing for sterile covering at the puncture site. 4 cases suffered from transient premature ventricular contraction(PVC),which was alleviated without malignant arrhythmia after immediate suspension of operation. In addition,2 cases were subject to balloon catheters in the right ventricle and 1 case had balloon catheter in pulmonary artery,where CO,CI,SVR and other values except for the pulmonary capillary wedge pressure(PCWP)could be measured in all cases. Balloon rupture,pulmonary embolism,pulmonary hemorrhage,and pulmonary artery rupture,catheter knotting and catheter rupture or phlebitis and complications of catheter-related bloodstream infection(CRBI)were not found in the 53 patients. Conclusions The application of Swan-Ganz balloon floating catheter can provide hemodynamic monitoring data and guidance for monitoring the treatment of patients receiving CABG.Scientific application and management of pulmonary artery floating catheters and effective nursing can prevent complications and adverse reactions.[S Chin J Cardiol 2019;20(2):95-102]     

A new technique for sheathless percutaneous intraaortic balloon catheter insertion

Intraaortic balloon counterpulsation is helpful for controlling myocardial ischemia and providing hemodynamic support, but its applicability is limited by lower extremity ischemic complications in a significant percentage of patients. We developed a new sheathless technique for percutaneous intraaortic balloon catheter insertion which reduces the effective catheter diameter. A pilot study using this new technique resulted in a 10% rate of limb ischemia, without compromise of balloon function. We conclude that this technique may be useful in reducing the incidence of limb ischemia associated with intraaortic balloon counterpulsation.     

Complications of the intraaortic balloon counterpulsation device: Clinical and morphologic observations in 45 necropsy patients

Of 45 patients who died after insertion of an intraaortic balloon assist device and who were studied at necropsy, 16 (36 percent) were found to have one or more complications (total 20) related to use of the device. The 20 complications consisted of dissection of the aorta or its distal branches, or both (9), arterial perforation (3), arterial thrombi (3), arterial emboli (3), limb ischemia (1) and local wound infection (1). Of the nine cases of arterial dissection, none were diagnosed or suspected before necropsy. Of the entire 20 complications, only 4 (20 percent) were suspected before death. Although the operating team frequently encountered no difficulty at the time of insertion of the device, 12 of the 20 complications were a direct result of insertion of the intraaortic balloon assist device. In two patients in whom insertion of the balloon caused dissection of the aorta, hemodynamic improvement occurred for 2 and 3 days, respectively, even though the “intraaortic” balloon (as well as the catheter) was not located in the true lumen of the aorta. Thus, clinical evaluation of complications related to use of the intraaortic balloon assist device underestimates their frequency. Most complications are consequences of insertion of the device, not consequences of its being in place.     

Comparison of wire-guided percutaneous insertion and conventional surgical insertion of intra-aortic balloon pumps in 151 patients

Over a 25-month period, percutaneous wire-guided balloon catheter insertion was attempted in 51 patients, and intra-aortic balloon pump insertion was attempted by conventional surgical method in 100 patients. The success rate in the group undergoing percutaneous insertion was 90.2 percent (46 of 51) and 90 percent in the group undergoing surgical insertion (90 of 100). The indications for intra-aortic balloon counterpulsation were diverse in both groups. The major complication rate in the patient population undergoing percutaneous intra-aortic balloon pump insertion was 15.2 versus 15.6 percent for the surgical group, and there were no cases of leg amputation or aortic dissection in the percutaneous group; however, two cases of leg amputation and one case of aortic dissection resulting in death occurred in the surgical group. The percutaneous intra-aortic balloon pump insertion technique was successfully employed in conjunction with percutaneous transluminal coronary angioplasty in six cases. It is concluded that the wire-guided percutaneous balloon catheter method is a highly successful and rapid means of instituting intra-aortic balloon counterpulsation in a wide variety of clinical situations. However, because of the significant associated complication rate, the decision to institute balloon counterpulsation must weigh the benefit-to-risk ratio, and this procedure must still be evaluated on a case-by-case basis.     

Outcome and complications of prolonged intraaortic balloon counterpulsation in cardiac patients.

The risks and benefits of prolonged intraaortic balloon support for the management of refractory congestive heart failure and ischemia were studied in patients with end-stage heart disease who needed support for greater than or equal to 5 days. Fifty-two insertions were performed by the percutaneous femoral route in 49 patients. The duration of insertion ranged from 5 to 46 days (mean 11.3). Clinical outcome including hemodynamic parameters and complications were recorded. Mean systemic arterial pressure did not change with balloon insertion (74 +/- 19 vs 76 +/- 11 mm Hg; p = not significant). Both the mean pulmonary artery and pulmonary arterial wedge pressures decreased (33 +/- 8 to 26 +/- 9 mm Hg [p less than 0.01], and 25 +/- 8 to 17 +/- 6 mm Hg [p less than 0.01], respectively). Over time, both parameters tended to increase, but remained significantly less than those before insertion. Cardiac index increased from 1.6 +/- 0.4 to 2.2 +/- 0.5 liters/min/m2 on insertion and continued to increase to 2.7 +/- 0.5 liters/min/m2 (p less than 0.01) before removal. Definite balloon catheter infection developed in 7 patients, and hemorrhage occurred in an additional 7. Eleven patients had vascular compromise, with loss of pulse in 6, thrombosis of the femoral artery in 1, and pseudoaneurysm in 2. Lacerated femoral artery occurred in 1 patient, and mesenteric artery thrombosis in another. Twenty patients died from progressive heart failure and multiorgan system failure, and 19 survived to receive left ventricular assist device and heart transplantation. Only 10 patients were weaned off the balloon. In conclusion, prolonged intraaortic balloon pump support may be successfully used in end-stage heart disease.     

Six years' experience with closed-chest decannulation of transthoracically inserted cardiac-assist balloon catheters

The efficiency and risks of a method that allows closed-chest decannulation of an intraoperatively inserted cardiac-assist balloon catheter are examined. The technique involves direct insertion of the balloon catheter into the ascending aorta under the protection of an indwelling silastic tourniquet. At the discretion of the surgeon, the tourniquet may be left in place or removed later through a small infrasternal incision. This method was applied for 6 years, from May 1985 to June 1991, in 18 patients. Satisfactory cardiac assistance was achieved in every patient, and no early or late complications or deaths were attributable to the technique. At the time of this report, 9 patients are still alive. The author recommends the application of the procedure whenever, in the course of open-heart operations, cardiac-assist intraaortic balloon pulsation becomes necessary and conventional transfemoral insertion is either impossible or inadvisable.     

Assessment of the "long sheath" technique for percutaneous aortic balloon valvuloplasty

A 100 cm-long 16.5 F valvuloplasty catheter introducer was assessed as an adjunct for percutaneous transluminal aortic valvuloplasty (PTAV) via the femoral artery in 31 patients with severe aortic stenosis. Observed improvements in peak systolic gradient (81.6 +/- 29.9 mm Hg vs. 35.5 +/- 16.0 mm Hg, P less than 0.000001) and aortic valve area (0.6 +/- 0.4 cm2 vs. 1.0 +/- 0.6 cm2, P less than 0.00001) were similar to those achieved in a control group (C) of 17 patients in which no femoral sheath was used. However, a shorter procedure duration (211 +/- 81 min vs. 117 +/- 30 min, P less than 0.001) and a reduced rate of vascular complications at the femoral puncture site (41% vs. 6.5%) were observed in patients in whom the long sheath (LS) technique was used. The frequency of other PTAV-related complications was comparable (C = 35%, LS = 29%, P = n.s.). Other technical advantages of this device are: 1) prevention of looping and bending of the balloon catheter in tortuous vessels and easy positioning of the balloon across the aortic orifice provided by the LS trackability, 2) stabilisation of the balloon during inflation, 3) monitoring of supravalvular aortic pressure provided by the side-arm of the LS and reliable measurement of systolic gradient, and 4) the ability to perform aortograms without the need of another catheter in the ascending aorta. Thus, in our experience, the long sheath technique is a valuable adjunct for PTAV.     

鞘管轨道在Inoue球囊导管进入股静脉中的应用

目的探讨自制鞘管轨道在解决经皮二尖瓣球囊扩张术（PBMV）中Inoue球囊导管沿左心房钢丝进入股静脉困难时的应用,并评价其可行性和安全性。方法 2008年1月至2014年6月在长海医院心内科住院的风湿性二尖瓣狭窄拟行经皮二尖瓣Inoue球囊扩张术的患者共136例,以术中出现Inoue球囊导管沿左心房钢丝进入股静脉困难的18例患者作为研究对象,采用7 F桡动脉血管鞘制作鞘管轨道引导Inoue球囊进入股静脉,观察Inoue球囊导入股静脉的成功率、手术成功率和穿刺处血管并发症。结果在鞘管轨道的辅助下,18例患者均成功将Inoue球囊导入股静脉,手术成功率100%,术后股静脉穿刺处未见静脉撕脱、皮下血肿等并发症发生。结论对于PBMV中Inoue球囊导管沿左心房钢丝进入股静脉困难的患者,使用鞘管轨道能够解决,顺利完成手术并避免穿刺部位出现血管并发症。