Thrombosis of the innominate artery during prolonged cardiac support by right transaxillary Impella 5.0 device


Submitted: 20 May 2020
Accepted: 6 November 2020
Published: 18 March 2021
Abstract Views: 508
PDF: 268
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

We describe an unexpected complication in a 46-years-old man affected by ischemic cardiomyopathy who received a prolonged mechanical cardiac support by means of right transaxillary Impella 5.0. The postoperative course was complicated by recurrent septicemia from multi-durg resistant Acinetobacter baumanii. He underwent implantation of venoarterial extracorporeal membrane oxygenation because of refractory cardiac arrest, followed by Impella removal that has been complicated by embolic stroke. The likely source of the embolus was a large thrombus inside the innominate artery. After a long-standing right transaxillary device implantation, particularly in patients with intercurrent septic episodes, a CT angiographic scan should be planned to exclude arterial thrombosis before removal of the transarterial device.


Chung JS, Emerson D, Ramzy D, et al. A new paradigm in mechanical circulatory support: 100 patient experience. Ann Thorac Surg 2020;109:1370-7. DOI: https://doi.org/10.1016/j.athoracsur.2019.08.041

Boll G, Fischer A, Kapur NK, Salehi P. Right Axillary Artery Conduit Is a Safe and Reliable Access for Implantation of Impella 5.0 Microaxial Pump. Ann Vasc Surg 2019;54:54-9. DOI: https://doi.org/10.1016/j.avsg.2018.10.004

Bertoglio L, Katsarou M, Scandroglio M, et al. Surgical transaxillary placement of the Impella 5.0 ventricular assist device. J Card Surg 2019;34:92-8. DOI: https://doi.org/10.1111/jocs.13978

Nakamura K, Krishnan S, Mahr C, McCabe JM. First-in-Man Percutaneous Transaxillary Artery Placement and Removal of the Impella 5.0 Mechanical Circulatory Support Device. J Invasive Cardiol 2017;29:E53-9.

Jones TL, Kearney KE, McCabe JM. Prevalence and Predictors of Vascular Thrombus Formation After Percutaneous Axillary Artery Impella Insertion. Circ Cardiovasc Interv 2019;12:e008046. DOI: https://doi.org/10.1161/CIRCINTERVENTIONS.119.008046

Castillo-Sang MA, Prasad SM, Singh J, et al. Thirty-five day Impella 5.0 support via right axillary side graft cannulation for acute cardiogenic shock. Innovations (Phila) 2013;8:307-9. DOI: https://doi.org/10.1097/imi.0000000000000009

Ranganath NK, Moazami N, Staniloae CS, Hisamoto K. Successful embolic protection during temporary circulatory support device removal in a patient who required holding of anticoagulation for postoperative hemothorax. J Thorac Cardiovasc Surg 2018;156:e203-4. DOI: https://doi.org/10.1016/j.jtcvs.2018.05.041

Cannata, A., Carrozzini, M., Tata, G., & Russo, C. F. (2021). Thrombosis of the innominate artery during prolonged cardiac support by right transaxillary Impella 5.0 device. Emergency Care Journal, 17(1). https://doi.org/10.4081/ecj.2021.9123

Downloads

Download data is not yet available.

Citations