Pulseless angiography

摘要

A left ventricular assist device (LVAD) is a mechanical device that can be placed in a patient with left ventricular functional compromise as a means to improve cardiac function. Typically, blood is pumped out from the ventricular apex, through the LVAD, and then back into the aorta via a cannula. The Figure is a surface-rendered three-dimensional reconstruction from a computed tomographic angiogram in a patient with a HeartMate II LVAD (Thoratec, Pleasanton, California). Use of the different types of LVADs result in continuous or pulsatile flow (Table). Patients harboring the continuous-flow type of LVAD will lack peripheral pulses; therefore, femoral access almost certainly will require ultrasound guidance. In addition, when the access needle is positioned in the femoral artery, continuous arterial flow emanating from the needle will be observed. Care should be taken to avoid damage to the pump mechanism by avoiding wire or catheter manipulation of the LVAD itself.