Abstract
We have performed a retrospective review of our experience with the intraaortic balloon
counterpulsation pump (IABP) during the last decade, to identify aspects of risk factors,
complications, and management that affect peripheral vascular morbidity and mortality.
Data from 472 patients who had the IABP inserted during the ten-year period from December
1985 to December 1995 were retrospectively reviewed. Risk factors, implantation techniques,
complications, and significant variables were evaluated. One hundred forty-five vascular
complications needed surgical therapy in 116 patients. Mean age was 62.2 ± 12.9 years.
There were 84 (72.5%) men and 32 (27.5%) women. Mortality rate was 28.3% (n = 181).
The mortality for patients with ischemic vascular complications was significantly
higher than in patients who did not suffer any vascular complication (59.6% vs 30.1
%, p = 0.0001). Complications included acute limb arterial occlusion in 99 cases (68.3
%), compartment Syndrome in 27 (18.6%), groin hematoma in 15 (10.3%), and persistent
lymph fistula in 4 (2.8%). Of these, 97 (76.9%) occurred during IABP therapy and 29
(23.1 %) after IABP explantation. Thromboembolectomy was required for 61 (42.2%) of
the ischemic limbs. Associated procedures were 24 (16.5%) profundaplasties, 10 (7%)
infrainguinal bypasses (5 (3.4.%) femoropopliteal supragenicular, 3 (2.2%) femoropopliteal
infragenicular, and 2 (1.4%) infrapopliteal), 26 (17.9%) fasciotomies, and 5 (3.4%)
amputations. A history of peripheral vascular disease (31 patients [43.6%] with vs
95 [23.6%] without, p < 0.05) and the presence of diabetes mellitus (70 patients [49.2%]
with vs 56 [16.9%] without) increased the risk of limb ischemia significantly. Female
sex, insertion of IABP by percutaneous technique, and direct removal with groin compression
were associated with higher ischemic complication rates, the differences however were
not significant. Itis concluded that I.Limb ischemia remains the primary complication
after IABP insertion; 2. Femoral artery thromboembolectomy is usually sufficient for
revascularisation; 3. Adequate implantation and surgical explantation techniques are
essential to reduce the lABP-related morbidity; 4. Identification of subclinical disease
may aid in the management of subsequent acute limb ischemia; 5. The presence of peripheral
vascular disease and diabetes mellitus are associated with higher ischemic complication
rates.
Key words
IABP - Vascular complications - Limb ischemia
