Complications of percutaneous intra-aortic balloon insertion

Abstract

Early studies reported that percutaneous intra-aortic balloons can be placed quickly and easily with minimal complications. To assess our experience with this technique, the records of the first 100 consecutive percutaneous intra-aortic balloon insertion attempts at our hospital were reviewed. In 21 insertion attempts, the balloon could not be passed retrograde into the thoracic aorta. Of the 79 patients in whom the balloon could be passed, 61 had no subsequent complications of balloon insertion. Ten patients, including three in whom insertion was unsuccessful, developed an ischemic limb or false aneurysm requiring surgical correction; among these, amputation was required in two extremities. One patient died as a result of iliac artery perforation by the balloon, and another patient required small bowel resection for mesenteric infarction during counterpulsation. The specific vascular injuries included six instances of femoral artery thrombosis related to laceration with intimal plaque elevation and one case of femoral artery thrombosis without laceration. There were three cases of false aneurysm of the femoral artery, with thrombosis in one. There was one case of iliac artery perforation. Techniques of repair included thrombectomy with lateral repair, vein or prosthetic-patch angioplasty, and simple suture repair of false aneurysm. Excluding five patients who died within 3 hours after balloon insertion and thus had no follow-up, major complications requiring surgical intervention occurred in 12 of 95 attempted insertions (12.6%). This complication rate prompted us to examine indications, risk factors that might predict complications, and potentially preventive techniques such as preinsertion aortography and the use of a wire guide or long sheath for insertion. Although percutaneous intra-aortic balloon insertion has proved to be a valuable technique, a significant number of complications have been seen. Careful selection of patients and insertion by experienced hands should minimize complications.