Vascular complications of intra-aortic balloon insertion in patients undergoing coronary reavscularization: analysis of 911 cases

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Abstract
Objective: Intra-aortic balloon pump (IABP) is a well-accepted and widely used mechanical circulatory support in cardiac surgical practice. We evaluated the vascular complications of IABP and risk factors associated with the development of these complications in patients undergoing myocardial revascularization. Methods: Between January 1994 and December 2000, a total of 911 patients undergoing coronary artery bypass grafting received IABP. The preoperative risk factors, balloon-related variables and vascular complications were studied and analyzed. Univariate and multivariate analyses were performed to identify risk factors for the development of vascular complications. Results: Mean age of the patients was 59.2±9.1 years and 10.5% of the patients were female. The incidence of diabetes and peripheral vascular disease was 41.1 and 8.5%, respectively. The mean Parsonnet score was 11.8±4.6. IABP was inserted by percutaneous technique in 96.8% of patients. The duration of IABP therapy ranged from 20 h to 21 days (mean 3.8 days). Fifty-four (5.9%) patients developed major and 53 (5.8%) patients developed minor vascular complications. Ischaemia of the limb, requiring thromboembolectomy, developed in 25 (2.7%) patients. Patients who received IABP preoperatively had higher incidence of major vascular complications as compared to patients who received IABP in operating room before induction of anaesthesia. Multiple logistic regression analysis revealed age, triple vessel disease, indications of IABP therapy (unstable angina, cardiac arrhythmia and haemodynamic instability), left ventricular aneurysm surgery and use of balloon with sheath as independent risk factors for the development of vascular complications. Conclusions: IABP therapy is associated with certain vascular complications, which should always be kept in mind before insertion of a balloon. The use of a balloon without sheath and proper evaluation of peripheral circulation can help to minimize the development of vascular complications.

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