Anatomic Suitability for Axillary Intra-Aortic Balloon Pump Circulatory Support.

Abstract

Background: Intra-aortic balloon pumps (IABP) are commonly used as a bridge to heart transplant (Htx). Although IABPs were designed for transfemoral arterial placement, axillary IABPs (axIABP) allow for continued ambulation and rehabilitation. However, increased rates of device complications with axillary compared to femoral insertion suggest anatomic variations that predispose patients to device failure.

Methods: We conducted a single-center retrospective study of patients who received axIABP as a bridge to HTx between February 2018 and July 2022. Pre-axIABP computed tomography (CT) images were reviewed for all patients, and anatomic features of the axillary and central arteries were measured and correlated with mechanical axIABP complications.

Results: A total of 48 patients underwent successful axIABP placement with available pre-insertion CT images, of whom 35 (72.9%) were male. Out of 48 patients, 26 (54.2%) experienced 34 complications, including axIABP rupture (n = 10, 29%), infection (n = 8, 23%), and thrombosis (n = 6, 18%). CTs showed an average axillary artery diameter and depth of 6.79 and 55.6 mm, respectively. The average subclavian artery takeoff angle from the aortic arch was 95.4°.

Conclusion: Of the 10 vascular anatomic features measured, there was no association between any single measurement and axIABP complications. However, there may be other structural features not measured by routine CT, technical issues with insertion, and device factors not accounted for in this study that drive axIABP complications. Nonetheless, our findings suggest that normal variations in the measured vascular anatomy should not preclude axIABP use.