Vascular complications of the intra-aortic balloon pump: an analysis of 436 patients.

Although the intra-aortic balloon pump can be a lifesaving device, vascular complications are often associated with its use. Four hundred thirty-six patients underwent insertion of a balloon pump over a 14-year period. Indications for the balloon pump were intraoperative pump failure (42%), unstable angina (24%), preoperative prophylaxis (22%), preoperative shock (9%), and postoperative support (3%). Placement of the intra-aortic balloon pump was by percutaneous insertion in 66 per cent of patients, the remainder were placed by direct exposure of the vessel. Vascular complications occurred in 46 (10.6%) patients. Limb ischemia was seen in 40 of 46 of these patients. Other complications included bleeding in three patients, dissection in two patients, and infection in one patient. The effects on morbidity of sex, diabetes, site of cardiac catheterization, duration of counterpulsation, and the presence or absence of pulses on admission were determined. Only the absence of pedal pulses on admission correlated with an increased incidence of vascular complications (P = 0.04). Twenty four per cent of those with complications were diabetics, compared with 16 per cent of patients who received balloon pumps but had no complications. Surgical interventions in the ischemic limbs consisted of thrombectomy alone (28 of 40) or thrombectomy and vascular bypass (5 of 40). Four femorofemoral crossover grafts and one saphenous vein interposition graft were used. Five limbs were lost to amputation, or 1 per cent of the entire group.(ABSTRACT TRUNCATED AT 250 WORDS)