Iatrogenic vascular trauma associated with intra-aortic balloon pumping: identification of risk factors.

The most important noncardiac consequence of use of the intra-aortic balloon pump (IABP) is associated iatrogenic vascular trauma. A retrospective analysis was undertaken of all patients at our institution (n = 90, mean age 60 years) who had insertion of an IABP over a 10-year period to assess the possibility of preoperative identification of patients at high risk of IABP associated vascular injury. Catheters were introduced via the common femoral artery (n = 84; 30 percutaneous, 4 open Seldinger technique, 50 via a dacron sleeve), external iliac artery (n = 2), and ascending aorta (n = 4). Thirty patients (33.3%) developed one or more complications, with 25 vascular complications, six major septic complications, and four deaths. Variables identified as significant risk factors for IABP complications were female gender (P < 0.01) and concomitant peripheral vascular disease (P < 0.05). Site of insertion, method or difficulty of insertion, age, duration of counterpulsation, and use of anticoagulation and antibiotics did not significantly affect the incidence of vascular complications (P > 0.05). In conclusion, prior to cardiac surgery, we recommend screening for peripheral vascular disease to identify patients at increased risk of complications should IABP counterpulsation be required. Ankle/brachial systolic pressure indices may be used to detect subclinical disease.