Vascular complications of intra-aortic balloon pumping
J. Alpert, E. K. Bhaktan, I. Gielchinsky, L. Gilbert, B. J. Brener, D. K. Brief and V. Parsonnet
Vascular injury or occlusion from intra-aortic balloon pumping (IABP) that
results in actual or potential limb ischemia occurs more frequently than
reported. In a series of 79 IABP patients, 36 lived long enough to have the
balloon catheter removed; thirteen (36%) of them had vascular
complications. The complications were in three patients with an injury at
the insertion site, eight patients with arterial thromboses, and two with
arterial occlusion by the large balloon catheter. Local artery revision,
thrombectomy alone, or thrombectomy with femorofemoral cross-over grafting
was required in 11 patients. Femorofemoral crossover graft was utilized
when arterial occlusion would have ordinarily required premature balloon
removal or when immediate arterial occlusion by the catheter was recognized
at the time of balloon insertion. This was preferable to transferring,
replacing, or discontinuing IABP, since the same factors that led to
thrombosis in the first place would have eventually come into play again.
Patients should be observed frequently and have Doppler limb pulse
determinations every four hours to avoid ischemic catastrophies. Proper
IABP weaning and the use of a Fogarty catheter at the time of balloon
removal is mandatory to prevent complications. Femorofemoral crossover
graft is indicated for ischemic limbs when IABP must be continued.
