VASCULAR COMPLICATIONS OF THE INTRAAORTIC BALLOON PUMP - AN ANALYSIS OF 436 PATIENTS

Although the intra-aortic balloon pump can be a life-saving device, va scular complications are often associated with its use. Four hundred t hirty-six patients underwent insertion of a balloon pump over a 14-yea r period. Indications for the balloon pump were intraoperative pump fa ilure (42%), unstable angina (24%), preoperative prophylaxis (22%), pr eoperative shock (9%), and postoperative support (3%). Placement of th e intraaortic balloon pump was by percutaneous insertion in 66 per cen t of patients, the remainder were placed by direct exposure of the ves sel. Vascular complications occurred in 46 (10.6%) patients. Limb isch emia was seen in 40 of 46 of these patients. Other complications inclu ded bleeding in three patients, dissection in two patients, and infect ion in one patient. The effects on morbidity of sex, diabetes, site of cardiac catheterization, duration of counterpulsation, and the presen ce or absence of pulses on admission were determined. Only the absence of pedal pulses on admission correlated with an increased incidence o f vascular complications (P = 0.04). Twenty four per cent of those wit h complications were diabetics, compared with 16 per cent of patients who received balloon pumps but had no complications. Surgical interven tions in the ischemic limbs consisted of thrombectomy alone (28 of 40) or thrombectomy and vascular bypass (5 of 40). Four femorofemoral cro ssover grafts and one saphenous vein interposition graft were used. Fi ve limbs were lost to amputation, or 1 per cent of the entire group. T hus, vascular complications of the intra-aortic balloon pump are not u ncommon; limb ischemia is the most prevalent. Patients most at risk fo r these complications are those with pre-existing vascular disease. Pr ompt surgical intervention is essential and results in salvage of most of these compromised limbs.