Prevention and Management of Acute Limb Ischemia when Using Temporary Mechanical Circulatory Support Devices.

Acute limb ischemia (ALI) is a significant and potentially limb- and life-threatening complication associated with all temporary mechanical circulatory support devices inserted into the peripheral arteries. Device-related ALI is principally due to obstruction of antegrade blood flow by large-caliber vascular sheaths and cannulas, but several clinical and patient-specific factors may increase risk. Prevention of device-related ALI is key and is achieved by identification of patients at elevated risk, careful percutaneous arterial access for device deployment, selection of the smallest clinically appropriate device or cannula, regular clinical monitoring during device use by standard physical examination and additional tools, and device explant as soon as clinically feasible. Placement of a distal perfusion catheter is now common practice to maintain adequate limb perfusion during venoarterial extracorporeal membrane oxygenation use and may additionally be used to treat ALI due to intraaortic balloon pump or Impella CP. Integrating best practices and perfusion strategies is essential to mitigate ALI-related morbidity and improve outcomes for patients requiring percutaneous temporary mechanical hemodynamic support.