LaMuraglia G M, Vlahakes G J, Moncure A C, Brewster D C, Buckley M J, Daggett W M, Palacios I, Cambria R, Akins C W, Torchiana D F
General Surgical Service, Massachusetts General Hospital, Boston 02114.
J Vasc Surg. 1991 Jun;13(6):830-5; discussion 836-7. doi: 10.1067/mva.1991.28413.
To determine the safety of intraaortic balloon pump catheter insertion for critical coronary ischemia through suprainguinal prosthetic bypass grafts, we examined our experience of 19 intraaortic balloon pumps placed through grafts in 17 patients by means of surgical exposure (8) or the percutaneous (11) approach. Fourteen intraaortic balloon pumps were placed through matured grafts at a time remote (2 to 13 years; mean, 7 years) from their vascular bypass surgery. Five were inserted through nonmatured grafts during the same hospitalization as their vascular reconstructive surgery (1 to 12 days; mean, 4 days). One patient, a day after an aortoiliac bypass, died during an urgent, surgical intraaortic balloon pump insertion for cardiogenic shock. All other patients had prompt reversal of their cardiac ischemia. Decreased limb perfusion developed during use of the intraaortic balloon pump in three patients, all of whom had their intraaortic balloon pump placed percutaneously through mature grafts. Two of these required surgical thrombectomy. Ten intraaortic balloon pump insertions in eight patients survived the hospitalization and were followed for a mean of 24 months (range, 2 weeks to 64 months). No localized groin or graft infections were identified. No bleeding complications or pseudoaneurysms occurred. Thus in patients with unstable, severe, cardiac disease, intraaortic balloon pumps can be safely placed through indwelling suprainguinal bypass grafts.
为了确定经腹股沟上人工血管旁路移植术进行主动脉内球囊反搏导管插入术治疗严重冠状动脉缺血的安全性，我们回顾了17例患者通过手术暴露（8例）或经皮（11例）途径植入19个主动脉内球囊反搏装置的经验。14个主动脉内球囊反搏装置是通过距血管旁路手术较远（2至13年；平均7年）的成熟血管旁路移植植入的。5个是在与血管重建手术同一住院期间（1至12天；平均4天）通过未成熟血管旁路移植植入的。1例患者在进行主动脉髂动脉旁路手术后一天，在因心源性休克进行紧急手术主动脉内球囊反搏插入术时死亡。所有其他患者的心脏缺血均迅速得到缓解。3例患者在使用主动脉内球囊反搏期间出现肢体灌注减少，这3例患者的主动脉内球囊反搏均是经皮通过成熟血管旁路移植植入的。其中2例需要进行手术取栓。8例患者中的10次主动脉内球囊反搏插入术患者存活至出院，并平均随访24个月（范围2周至64个月）。未发现局部腹股沟或血管旁路移植感染。未发生出血并发症或假性动脉瘤。因此，对于不稳定的重症心脏病患者，可通过留置的腹股沟上血管旁路移植安全地植入主动脉内球囊反搏装置。
