A case of ultra-prolonged intra-aortic balloon pump support via sheathless femoral access.

Background: An intra-aortic balloon pump (IABP) is a mechanical circulatory support platform with a relatively low complication rate. Axillary access is increasingly utilized to allow rehabilitation. Case summary: We present a case of femoral IABP inserted into the femoral artery percutaneously via a sheathless technique that allowed the patient to ambulate and physically rehabilitate over 102 days until cardiac transplantation. The patient was able to progress with the protocolized rehabilitation programme to up to 3500 ft walking distance. The IABP was removed at the time of transplantation without any vascular complications. Discussion: While axillary IABP offers an opportunity to rehabilitate, it has an unacceptably high complication rate, often resulting in vascular injury that adds morbidity to an acutely ill cohort. In this case, we found that sheathless femoral IABP access offered stability for a prolonged time while avoiding pain, bleeding, infection, and vascular injury. We hypothesize that this is due to less indwelling prosthetic material usage and also device flexibility, allowing conformation to the natural course of the femoral artery. We are encouraged by this case to use a sheathless access approach for patients expected to require prolonged IABP support.