Ischaemic complications with intra-aortic balloon counter-pulsation: incidence and management

The most important limitation of the use of the intra-aortic balloon pump i s the risk of vascular complications. The aim of this study was to identify risk factors and aspects of diagnosis and management that may decrease the risk of vascular morbidity associated with intra-aortic balloon pumps. Ris k factors, surgical techniques, complications and other variables were retr ospectively evaluated in 524 patients who had an intra-aortic balloon pump inserted between January 1988 and December 1998. Of the total, 140 (26.7%) patients with an intra-aortic balloon pump had ischaemic complications that needed surgery. The mean age was 65.2 +/- 12.3 years (66.7% men and 27.5% women). The mortality rate was 28.1%. The mortality for patients with ischa emic vascular complications was significantly higher than in those patients without (59.6 versus 30.1%, P = 0.001). One-hundred and eight (77.2%) isch aemic complications occurred during therapy with an intra-aortic balloon pu mp and 32 (22.8%) complications after intra-aortic balloon pumping had been stopped. Thromboembolectomy was required in 71 (50.7%) patients. Associate d surgical procedures were performed in 69 (49.3%) patients. A history of p eripheral vascular disease (43.6 versus 23.6%, P < 0.05) and the presence o f diabetes mellitus (49.2 versus 16.9%, P < 0.05) increased the risk of lim b ischaemia significantly. Limb ischaemia remains the major complication af ter intra-aortic balloon pump insertion. Independent predictors for vascula r complications included peripheral vascular disease and diabetes. Intra-ao rtic balloon pump removal and thrombectomy is usually sufficient to provide revascularization. Identification of subclinical disease may aid in the ma nagement of subsequent acute limb ischaemia. (C) 2000 The International Soc iety for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rig hts reserved.