Extraction of a Lost Intra-Aortic Balloon Pump
Guidewire
Manouchehr Hekmat
1
, Hamid Ghaderi
2,*
, Seyedeh Adeleh
Mirjafari
3
, Mehran Shahzamani
2
, Gholamreza Masoumi
4
1
Department of Cardiovascular Surgery, Shahid Modarres Hospital, Shahid Be-
heshti University of Medical Sciences, Tehran, Iran
2
Department of Cardiovascular Surgery, Chamran Heart Center Hospital, Isfahan
University of Medical sciences, Isfahan, Iran
3
Tehran University of Medical Sciences, Tehran, Iran
4
Department of Cardiac Anesthesiology, Chamran Heart Center Hospital, Isfahan
University of Medical sciences, Isfahan, Iran
* Corresponding author: Hamid Ghaderi, MD, Department of Cardiovascular
Surgery, Chamran Heart Center Hospital, Isfahan University of Medical sciences,
Isfahan, Iran. E-mail: hghaderi@razi.tums.ac.ir
Abstract
Guidewire loss is a serious complication that in case of a complete wire loss could cause
death in about 20% of cases. Although it is essential to retrieve an intravenous foreign
body as soon as possible, there are only a few recommendations regarding the removal of
an intra-arterial foreign body. is study reports on a rare complication of guidewire loss
during the insertion of an Intra-Aortic Balloon Pump (IABP), which has not yet been
reported in the literature. e approach to this problem has been described, including
the extraction time and the technique.
© 2018. International Journal of
Cardiovascular Practice.
Submited: 12-19-2017
Accepted: 01-02-2018
Keywords:
Catheterization
Intra-Aortic Balloon Pump
Guidewire Methods
Int J Cardiovasc Pract�
January 2018, Volume 3, Issue 1 (18-19)
Case report
DOI: 10.21859/ijcp-03105
INTRODUCTION
e Seldinger technique that was primarily used during ra-
diographic approaches is currently used to perform different
procedures, such as the placement of central venous cathe-
ters, hemodialysis catheters, and arterial catheters [1, 2].
Although percutaneous catheterization is a routinely per-
formed technique, it requires highly experienced and quali-
fied personnel for aending to technical details to minimize
complications. As any other invasive procedure, this tech-
nique is also associated with certain risks and complications.
Although these complications have been rarely reported in
correlation with a guidewire, if they occur, they can lead to
serious morbidity or even mortality. Different methods are
used for the extraction of an intravascular foreign body, such
as a goose neck snare [3], Dormia basket [4], two-wire tech-
nique or biopsy forceps 6-F [5], and finally surgical interven-
tions. is study reports a rare complication of guide wire
loss during the insertion of an Intra-Aortic Balloon Pump
(IABP), which has not yet been reported in the literature.
is study explains the approach to this problem, including
the extraction time and the technique.
CASE PRESENTATION
e patient was a 64-year-old male, who underwent Coro-
nary Artery Bypass Graſt (CABG) surgery for his coronary
artery disease. At the end of the surgery, a decision was made
for IABP insertion due to low cardiac output. e procedure
was initiated through the Seldinger technique over the right
common femoral artery. Unfortunately, before the guidewire
appeared at the end of the balloon catheter, the surgeon in-
serted the catheter into the femoral artery and advanced it
completely and the assisting technician did not inform about
the loss of the guidewire. On routine chest X-ray control at
the Intensive Care Unit (ICU), the surgeon noticed rolling of
the guidewire in the thoracic aorta (Fig 1).
Figure 1: CXR showing a Misplaced Guidewire and the Placement
of IABP