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