Large-bore endovascular devices such as intra-aortic balloon pump and percutaneous left ventricular assist devices are being utilized with increasing frequency as endovascular and percutaneous techniques are developed for the management of cardiovascular disease. Improvements in design, insertion technique, and operator experience have lowered the incidence of vascular complications associated with IABPs, but there remains significant room for improvement. Currently approved percutaneous LVADs require large sheath sizes and are consequently associated with much higher incidence of vascular complications. In the past, open repair was required for many vascular complications, but in recent years endovascular management has become available and, in some cases, is now the preferred approach for management. In this chapter we discuss the endovascular approach to treatment and techniques to reduce incidence of vascular complications from large-bore vascular devices.
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