Lower limb ischemia related to use of the intraaortic balloon pump

Article Abstract:

The intraaortic balloon pump (IABP) is a device that helps a damaged heart pump blood to the body. A small balloon is inserted through a vein in the leg and guided up through the heart to a large artery called the descending aorta. Once here, it is repeatedly inflated and deflated (counterpulsated), which moves blood from the heart to the tissues. IABP counterpulsation is also used in the management of chest pain, during heart surgery, and in heart attack patients. Although this is a useful device, it can decrease the flow of blood (ischemia) through the limb in which it was inserted. Ischemia may result from the formation of small blood clots in the blood vessels leading to the limb or from damage to the blood vessel wall where the IABP was inserted. IABP counterpulsation-induced lower limb ischemia occurs in 0 to 42 percent of the patients and is associated with abnormal temperature, color, gangrene, and pain of the affected limb. A recent study of 249 patients examined the incidence of IABP counterpulsation-induced lower limb ischemia over a 16-month period and assessed the risk factors for its development. Lower limb ischemia occurred in 47 percent of patients, and became serious in 14 percent of patients. The associated mortality for IABP counterpulsation-treated patients was 24 percent. Women and patients with prior blood vessel disorders or diabetes mellitus had an increased risk of developing IABP counterpulsation-induced lower limb ischemia as compared to other patients. Patients with a smoking habit, diabetes mellitus, or heart-induced decrease in peripheral blood flow had an increased risk of developing severe lower limb ischemia. In conclusion, IABP counterpulsation is useful, but may be complicated by serious lower limb ischemia. It is suggested that patients who are female or with a smoking habit, diabetes mellitus, or a prior history of blood vessel disease, be carefully monitored during IABP counterpulsation treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Complications and side effects, Ischemia, Balloon dilatation, Intra-aortic balloon counterpulsation

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Cerebral balloon angioplasty for treatment of vasospasm after subarachnoid hemorrhage

Article Abstract:

Cerebral vasospasm refers to the constriction or narrowing of blood vessels in the brain. When vasospasm occurs, it reduces the amount of blood that can pass through the blood vessel and decreases the amount of oxygen delivered to the tissue. Cerebral vasospasm can be caused by a ruptured aneurysm (an abnormal dilation in the blood vessel) that results in bleeding in the brain (subarachnoid hemorrhage). This is a leading cause of disability and death. The vasospasm can impair the function of the central nervous system, causing lethargy, confusion, paralysis, coma, and death. Computed tomography (CT scan) and angiography are common procedures used to diagnose cerebral vasospasm. The goal in treating vasospasm is to restore normal blood flow to the affected region of the brain, thereby reducing the risk of brain damage. Several different types of drug treatments are available for cerebral vasospasm. These include increasing the blood pressure with dopamine, preventing the contraction of smooth muscle with nimodipine, and reducing the viscosity of the blood. Patients who do not respond to drug treatment may be candidates for a procedure called transluminal percutaneous cerebral angioplasty. This procedure uses a balloon-tipped catheter that is passed through the femoral artery in the thigh, up into the aorta, and then into the brain. When the area containing the vasospasm is reached, the tip of the catheter is inflated, which dilates the blood vessel. A type of imaging technique called Doppler ultrasonography can be used to determine the effectiveness of the angioplasty. In one study, this technique was effective in maintaining normal blood flow in the brain for three years. The risks involved with cerebral angioplasty include bleeding, rupture of the balloon tip, rupture of the blood vessel, worsening of the neurologic symptoms, reclosing of the blood vessel, and death from severe vasospasm. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Transluminal angioplasty, Balloon angioplasty, Arteries, Cerebrovascular spasm

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Hypervolemic hemodilution: a new approach to subarachnoid hemorrhage

Article Abstract:

A subarachnoid hemorrhage (SAH) is the sudden accumulation of blood in the subarachnoid space, which is located beneath one of the membranes that covers the brain. SAH affects thousands of Americans each year and the mortality associated with it is very high. Causative factors of SAH include trauma, brain tumors, and anomalies of brain blood vessels. Primary SAH occurs with hemorrhage directly onto the surface of the brain and secondary SAH occurs when bleeding occurs into the brain tissue or ventricles that are spaces located within the brain. After a hemorrhage, brain blood vessels constrict and brain blood thickness increases; these effects decrease brain blood flow and may lead to brain damage and death. A new therapy called hypervolemic hemodilution is designed to treat SAH patients with a decrease in brain blood flow by decreasing blood thickness. Hypervolemic hemodilution is a medically-induced increase in total blood volume that is produced by the infusion of volume expanders such as five percent albumin, plasma, or dextrans. To qualify for treatment, a patient must have SAH and have a neurological exam that indicates medical intervention is necessary to prevent brain damage or death. Five percent albumin is infused for three to seven days then slowly tapered before discontinuation of therapy. The effectiveness of therapy is assessed by improvements in the neurological status of the patient and brain blood flow measurements. The critical care nurse administers the therapy and can educate patients and their families about the SAH and its treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Subarachnoid hemorrhage, Brain, Brain hemorrhage, Albumin

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