Contraindications and complications
As with other mechanical support devices, severe peripheral vascular disease is a relative contraindication for femoral access due to the risk of limb ischaemia. The presence of a mechanical aortic valve is considered an absolute contraindication, while severe aortic stenosis as a relative contraindication [8].
Potential complications related to the use of Impella are device-related, peripheral vascular and distal thrombus formation with subsequent strokes. According to a recent report, the most common complications reported were bleeding requiring transfusion (17.5%), vascular access complications (15.2%), infection (12.9%), haemolysis (10.3%), vascular complications with a need of surgical repair (9.7%), limb ischaemia (3.9%) and bleeding requiring surgical intervention (2.6%) [8, 13]. Valvular complications included aortic and mitral valve injury or regurgitation.