Discussion
To the best of our knowledge, this is the first case report of a
successful thoracic endovascular repair of an aortic rupture caused by
axillary IABP insertion. Moreover, this patient had a challenging
medical background including situs inversus totalis with dextrocardia
anomaly and refusal of blood transfusions.
Currently, there are several options for mechanical circulatory support
for heart failure. However, an IABP is still the most frequently used
circulatory support device in the United States[1]. A femoral IABP
is easy to place and is a minimally invasive procedure. In our
institution, we commonly place axillary IABPs for selected heart failure
patients. The axillary IABP has some advantages over the traditional
femoral IABP, especially in regard to patient mobility. Unlike femoral
IABP, patients can ambulate with an axillary IABP console. Because
physical therapy has been recognized as one of the most important
therapies for heart failure, maintaining patient mobility is a huge
advantage[2]. As the clinical benefits of axillary IABP have been
reported in some papers[3,4], axillary IABP is considered a safe and
effective circulatory support. However, we have safely performed
axillary IABP over the last 10 years, and this is the first case of
iatrogenic aortic rupture in our experience.
Although some centers report excellent surgical outcomes for Jehovah’s
witness patients, there are few reports about emergent and complex
aortic surgery in this patient group[5,6]. It is a formidable
challenge to perform emergent open aortic surgery without any blood
transfusions. In contrast, endovascular surgery is less invasive and can
be performed without the need for blood transfusion[7]. Therefore,
endovascular repair should be considered as first-line therapy for
selected patients with a complicated background, including Jehovah’s
witness patients.
Conclusion
In conclusion, we present a unique case of an iatrogenic aortic rupture
caused by axillary IABP in a Jehovah’s witness patient with situs
inversus anomaly. Endovascular repair was successfully performed without
the need for any blood transfusions.
Acknowledgement; none
Disclosures;
Ross Milner; consultant for Endospan, Medtronic and WL Gore
Author contributions;
Hidefumi Nishida; concept, drafting article
Tae Song MD; Critical revision of article, Approval of article
Valluvan Jeevanandam, MD; Critical revision of article, Approval of
article
Trissa A. Babrowski, MD; Critical revision of article, Approval of
article
Ross Milner, MD; Concept, Critical revision of article, Approval of
article