# Bailout Procedure Utilizing Balloon Dilatation for a Percutaneous Micro-axial Flow Pump Entrapped Within a Significantly Calcified Subclavian Artery

## TL;DR

This paper describes a successful balloon dilation technique to remove a cardiac pump lodged in a calcified artery, avoiding surgery and complications.

## Contribution

A novel bailout procedure using balloon dilatation is proposed for safely extracting a percutaneous micro-axial flow pump from a calcified subclavian artery.

## Key findings

- Balloon dilation enabled safe extraction of the IMPELLA 5.5 device from a severely calcified subclavian artery.
- No vascular complications were observed one month after the procedure.
- The method offers a potential solution for managing similar device entrapment cases.

## Abstract

The IMPELLA 5.5 (Abiomed Inc., Danvers, Massachusetts, United States) is a catheter-based, micro-axial blood pump designed to enhance organ perfusion in patients with cardiogenic shock. Despite its superior hemodynamic support, vascular complications are a significant concern, with many patients needing to discontinue IMPELLA therapy due to these issues. Patients may even require surgical intervention to address device-related vascular injuries. The IMPELLA 5.5 implantation in vessels with severe calcification is particularly associated with complications such as vascular calcification, stenosis, vascular tortuosity, and the use of larger sheaths are risk factors following endovascular therapy and IMPELLA implantation. In this report, we present a case of severe calcification in the right subclavian artery, in which the IMPELLA 5.5 was lodged. The calcifications protruded into the vascular lumen, becoming lodged between the IMPELLA motor and the cannula, complicating extraction despite the vessel having sufficient diameter. We successfully removed the device using a balloon dilation technique, ensuring safe extraction. No vascular complications such as pseudoaneurysm or dissection were observed in the right subclavian artery one month after extraction. This case highlights a potential approach for managing similar complications and vascular access for IMPELLA insertion.