IATROGENIC VASCULAR TRAUMA ASSOCIATED WITH INTRAAORTIC BALLOON PUMPING - IDENTIFICATION OF RISK-FACTORS

The most important noncardiac consequence of use of the intra-aortic b alloon pump (IABP) is associated iatrogenic vascular trauma. A retrosp ective analysis was undertaken of al patients at our institution (n=90 , mean age 60 years) who had insertion of an IABP over a 10-year perio d to assess the possibility of preoperative identification of patients at high risk of IABP associated vascular injury. Catheters were intro duced via the common femoral artery (n=84;30 percutaneous, 4 open Seld inger technique, 50 via a dacron sleeve), external iliac artery (n=2), and ascending aorta (n=4). Thirty patients (33.3%) developed one or m ore complications, with 25 vascular complications, six major septic co mplications, and four deaths. Variables identified as significant risk factors for IABP complications were female gender (P<0.01) and concom itant peripheral vascular disease (P<0.05). Site of insertion, method or difficulty of insertion, age, duration of counterpulsation, and use of anticoagulation and antibiotics did not significantly affect the i ncidence of vascular complications (P>0.05). In conclusion, prior to c ardiac surgery, we recommend screening for peripheral vascular disease to identify patients at increased risk of complications should IABP c ounterpulsation be required. Ankle/brachial systolic pressure indices may be used to detect subclinical disease,