CTICasesIntra-Aortic Balloon Pump via Axillary Approach
Imaging findings
Portable chest radiographs demonstrate an intra-aortic balloon pump (IABP) with the proximal marker clip projecting high near the aortic arch and visible lucency (helium gas) in the driveline extending toward the left axilla, consistent with axillary artery insertion. An earlier image shows the balloon tip inappropriately extending into the proximal subclavian artery territory.
Key takeaways
IABPs placed via the axillary (subclavian) artery are inserted in an inverted orientation compared to the standard femoral approach, with the catheter directed downward. The proximal (upper) marker clip appears high near the aortic arch, which can be misinterpreted as malposition. Recognition of gas in the driveline tracking to the axilla and correct identification of the proximal versus distal markers is essential to avoid erroneous recommendations to advance the balloon.
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