Successful control of intractable Impella 5.5 graft site bleeding using a Viabahn stent graft: A case report.

UNLABELLED: Impella 5.5 (Abiomed Inc., Danvers, MA, USA) provides effective mechanical circulatory support in severe heart failure but requires surgical implantation via a prosthetic graft, which may be complicated by bleeding. We report a case of uncontrollable oozing hemorrhage at the axillary graft anastomosis site during Impella 5.5 support in a 35-year-old man with acute decompensated heart failure due to idiopathic cardiomyopathy. The patient had previously been supported with Impella CP, resulting in severe coagulopathy. To control the bleeding while preserving limb perfusion, a Viabahn covered stent (Vascutek Ltd, Inchinnan, United Kingdom) was deployed in the right subclavian artery to cover the graft anastomosis site, achieving immediate and complete hemostasis. After subsequent recovery of cardiac function, the Impella 5.5 was safely explanted. Viabahn stent graft placement may be an effective rescue strategy for intractable graft site bleeding during Impella 5.5 support when standard surgical hemostasis fails, allowing continuation of mechanical support and safe device removal. LEARNING OBJECTIVE: Impella 5.5-related graft-site bleeding associated with coagulopathy after Impella CP or extracorporeal membrane oxygenation can be effectively controlled by Viabahn stent graft placement when conventional surgical hemostasis fails.