Surgical removal of intra-aortic balloon catheter with fractured nitinol central lumen: A case report

Abstract

A 73-year-old woman suffering from septic shock was given circulatory assistance by intra-aortic balloon pumping (IABP). Eleven hours later, pumping stopped abruptly and blood reflux was observed in the intra-aortic balloon catheter (IABC). We removed it and inserted another IABC; 3.5 h later, pumping stopped again and blood reflux was seen. Removal of the IABC was attempted, as the systolic aortic pressure remained above 100 mmHg, but there was resistance during the removal and as a result 7.5 cm of the catheter from the tip remained inside the vessel. Fluoroscopy indicated that the metal tube that formed the central lumen in the balloon was fractured, and that its edge had perforated the femoral artery. The balloon was then removed surgically. Fracture of the metal tube and balloon perforation were confirmed in both the damaged IABCs. Postoperative computed tomography and magnetic resonance imaging indicated a highly severe posterior- anterior bend in the patient's aorta. A vessel model similar to the aorta in this case was made and a reproducibility test was conducted; the central lumen fractured within 3 h and under a microscope the profile of the fractured test lumen was similar to the one in the clinical case. These findings suggest that placing a pumping IABC in a bending aorta causes fracture of the central lumen from fatigue failure because the central lumen is under excessive stress.