Complications of intra-aortic balloon insertion and counterpulsation.

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Abstract
For 100 consecutive patients considered as candidates for intra-aortic balloon pumping (IABP), the complications and difficulties encountered with balloon catheter insertion were reviewed. A single attempt at positioning the balloon in the descending thoracic aorta proved successful in 73% of these patients, but the standard femoral artery approach proved difficult in 27% and impossible in 21%. Eighty-two patients ultimately underwent counterpulsation using various insertion techniques. The overall complication rate was 23%. The incidence of complications was higher in those who never had IABP than in those who did. Major complications included iatrogenic dissection (7), free perforation (1), limb ischemia (10) and septicemia (2) and resulted in 2 deaths. Catheter tip injury of an atherosclerotic arterial wall was common to many of these, particularly in the aorto-iliac-femoral artery segment. Successful treatment of these problems necessitates balloon removal and catheter thrombectomy when hemodynamically feasible or a change in the access site. In addition, repair of arterial injury may be necessary. Thrombocytopenia is universal in these patients, although rarely to a significant degree. Three complications relating to the lymphatic system were encountered which resulted in increased morbidity. The number and magnitude of complications demonstrated in this series must be weighed against the expected advantages of IABP, particularly in that group who might be managed effectively without this procedure.

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