Vascular complications of prolonged intra-aortic balloon counterpulsation in cardiac surgical patients

Abstract

Background. Use of intra-aortic balloon pump (IABP) is associated with certain vascular complications, which are likely to develop more frequently in patients where IABP is used for prolonged period. The present study was undertaken to analyze vascular complications after prolonged IABP use in patients undergoing various cardiac surgical procedures. Methods. Between January 1995 and February 2001, a total of 1130 patients (7.4% of all adult patients undergoing cardiac procedures) required IABP counterpulsation, out of which 220 patients required IABP for more than 4 days. The vascular complications in these patients were studied. The IABP was inserted by percutaneous technique in 211 (95.5%) patients. The mean age of the patients was 57.5±9.5 years and 15% patients were female. The prevalence of peripheral vascular disease was 11.8%. Results. The duration of IABP therapy ranged from 5 days to 21 days with mean duration of 9.71±4.29 days. A total of 41 complications developed in 38 (17.3%) patients. Acute lower limb ischemia, requiring urgent surgical intervention, was the commonest major complication, which developed in 17 patients. This required thromboembolectomy in 11 patients and femoro-femoral bypass in 3 patients. One patient developed gangrene of the leg, requiring below knee amputation. On multivariate analysis, peripheral vascular disease, preoperative serum creatinine, surgery for LV aneurysm and unstable angina and hemodynamic instability (as the indications for IABP) were found as the predictors of vascular complications. Conclusions. Prolonged use of IABP counterpulsation is associated with significant incidence of vascular complications. Proper assessment of peripheral circulation before IABP insertion and appropriate management of ischemic complications are important to avoid limb loss to the patient.