Takagi Kazuyoshi, Otsuka Hiroyuki, Saku Kosuke, Tayama Eiki
Division of Cardiovascular Surgery, Department of Surgery, Kurume University, Kurume, JPN.
Cureus. 2024 Jul 30;16(7):e65804. doi: 10.7759/cureus.65804. eCollection 2024 Jul.
The IMPELLA 5.5 (Abiomed Inc., Danvers, Massachusetts, United States) is a catheter-based, micro-axial blood pump designed to enhance organ perfusion in patients with cardiogenic shock. Despite its superior hemodynamic support, vascular complications are a significant concern, with many patients needing to discontinue IMPELLA therapy due to these issues. Patients may even require surgical intervention to address device-related vascular injuries. The IMPELLA 5.5 implantation in vessels with severe calcification is particularly associated with complications such as vascular calcification, stenosis, vascular tortuosity, and the use of larger sheaths are risk factors following endovascular therapy and IMPELLA implantation. In this report, we present a case of severe calcification in the right subclavian artery, in which the IMPELLA 5.5 was lodged. The calcifications protruded into the vascular lumen, becoming lodged between the IMPELLA motor and the cannula, complicating extraction despite the vessel having sufficient diameter. We successfully removed the device using a balloon dilation technique, ensuring safe extraction. No vascular complications such as pseudoaneurysm or dissection were observed in the right subclavian artery one month after extraction. This case highlights a potential approach for managing similar complications and vascular access for IMPELLA insertion.
Impella 5.5（美国马萨诸塞州丹弗斯市的Abiomed公司）是一种基于导管的微轴血泵，旨在增强心源性休克患者的器官灌注。尽管其具有卓越的血流动力学支持作用，但血管并发症仍是一个重大问题，许多患者因这些问题需要停止使用Impella治疗。患者甚至可能需要手术干预来处理与设备相关的血管损伤。在严重钙化的血管中植入Impella 5.5尤其会引发诸如血管钙化、狭窄、血管迂曲等并发症，并且使用较大的鞘管是血管内治疗和植入Impella后的危险因素。在本报告中，我们呈现了一例右锁骨下动脉严重钙化的病例，其中Impella 5.5被困在该动脉中。钙化突出到血管腔内，卡在Impella电机和插管之间，尽管血管直径足够，但仍使取出过程变得复杂。我们使用球囊扩张技术成功取出了该设备，确保了安全取出。取出后一个月，右锁骨下动脉未观察到诸如假性动脉瘤或夹层等血管并发症。该病例突出了一种处理类似并发症以及为Impella插入提供血管通路的潜在方法。
