Rescue transbrachial intra-aortic balloon insertion followed by percutaneous vascular access suture – case report

We describe a case of a 66-year-old man, with ischaemic cardiomyopathy, unstable angina and severe peripheral artery disease in whom after a successful percutaneous coronary intervention (PCI) of the circumflex branch with drug-eluting stent implantation, increasing vasoconstriction of the distal segment on guidewire occurred, resulting in vessel and systemic flow impairment, followed by cardiogenic shock. After about 1 h of resuscitation, due to haemodynamic instability, intra-aortic ballon pump (IABP) insertion via the transbrachial route was mandatory. Several minutes after IABP insertion, haemodynamic stabilization was obtained. Two h after admission to the Cardiac Intensive Care Unit (CICU) the patient regained consciousness. The IABP was removed 16 h later with vascular access suture Angio-Seal applied. The transbrachial route may be considered as IABP access in patients with no other access route, but due to the small vessel diameter along with technical difficulties there is always a risk of artery thrombosis or limb ischaemia.