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Removal of Percutaneous Intraaortic Balloon
123 Correspondence
Reply To the Editor: The point made by Bonchek and Olinger deserves reemphasis, and we regret not having cited their original contribution. We routinely apply distal compression and permit free bleeding for a moment during withdrawal of a transfemoral balloon catheter, since thrombosis of the iliac or common femoral vessel is not uncommon after percutaneous insertion, particularly in patients with evidence for occlusive disease or low output states. Similarly, on withdrawal of a balloon catheter from the ascending aorta, we allow free bleeding during the removal and prior to tightening of the pursestring suture, in the hope of recovering any thrombus contained within the aortic lumen. All our patients on intraaortic balloon pump support in the early postoperative period are maintained on heparin anticoagulation; examination of the balloon catheters removed from the femoral artery has not suggested clot formation on the sheath per se, but
rather at the puncture site or within the small diameter of a diseased iliofemoral vessel. We anticipate that any clot in the ascending aorta will be on the endothelial surface at the site of puncture, and we have thus been content with a moment of free external bleeding during catheter withdrawal. We have not purposely utilized carotid compression, and to our knowledge, have not dislodged systemic thromboembolism in the few instances in which ascending aortic counterpulsation has been required. However, we do agree with the cautions of Bonchek and Olinger, and are grateful to them for reemphasizing the utility of this rapid, life-saving maneuver and the potential embolic problems that may develop.
Kevin N . Melvin, M . D . Bernard S . Goldman, M . D . Department of Cardiovascular Surgery Eaton North, 13-225 Toronto General Hospital Toronto, Ont M56 1L7, Canada
Reply To the Editor: The point made by Bonchek and Olinger deserves reemphasis, and we regret not having cited their original contribution. We routinely apply distal compression and permit free bleeding for a moment during withdrawal of a transfemoral balloon catheter, since thrombosis of the iliac or common femoral vessel is not uncommon after percutaneous insertion, particularly in patients with evidence for occlusive disease or low output states. Similarly, on withdrawal of a balloon catheter from the ascending aorta, we allow free bleeding during the removal and prior to tightening of the pursestring suture, in the hope of recovering any thrombus contained within the aortic lumen. All our patients on intraaortic balloon pump support in the early postoperative period are maintained on heparin anticoagulation; examination of the balloon catheters removed from the femoral artery has not suggested clot formation on the sheath per se, but
rather at the puncture site or within the small diameter of a diseased iliofemoral vessel. We anticipate that any clot in the ascending aorta will be on the endothelial surface at the site of puncture, and we have thus been content with a moment of free external bleeding during catheter withdrawal. We have not purposely utilized carotid compression, and to our knowledge, have not dislodged systemic thromboembolism in the few instances in which ascending aortic counterpulsation has been required. However, we do agree with the cautions of Bonchek and Olinger, and are grateful to them for reemphasizing the utility of this rapid, life-saving maneuver and the potential embolic problems that may develop.
Kevin N . Melvin, M . D . Bernard S . Goldman, M . D . Department of Cardiovascular Surgery Eaton North, 13-225 Toronto General Hospital Toronto, Ont M56 1L7, Canada