Complications of intra-aortic balloon counterpulsation, with special reference to limb ischemia.

During a 5-year period, intra-aortic balloon pumping (IABP) was performed on 90 patients (3.1% of those undergoing open-heart surgery), using a Percor catheter inserted with Seldinger technique. Overall prognosis was poor; only 46 of the 90 patients were alive at postoperative follow-up averaging 23 months. Limb ischemia arose in 20%, with incidence uninfluenced by catheter insertion technique (percutaneous v. 'open'). Surgical treatment was required for half of the ischemic limbs. Groin hematoma commonly followed percutaneous extraction of IABP catheter, whereas 'open' removal was always hemostatic, with potential for embolectomy. Percutaneous insertion of IABP catheter via the femoral artery is the method of choice in an emergency situation. 'Open' Seldinger technique is preferable in the operating room. For elective IABP catheter removal, the 'open', hemostatic technique is recommended. If limb-threatening ischemia develops, the catheter must be removed. If the patient is IABP-dependent, the contralateral femoral artery or the ascending aorta should be considered as an alternative catheter route.