Major complications occur in 8.5 per cent of cases and IABP-related mortality is about 0.8 per cent ( McEn.any.efal 1978). The majority of complications are related to vascular problems and thrombosis, in relation to the site of insertion, is the most common complication. Less common, but very serious, complications include embolism, arterial dissection, and laceration. Pseudoaneurysm formation and femoral artery stenosis can also occur after balloon removal.

Limb ischemia is a serious complication. The majority require embolectomy, but a minority may require a vascular repair or a bypass procedure or even amputation. If the relevant limb becomes ischemic, a very careful assessment of the overall state of the patient must be made. If the patient is judged not to require IABP support any longer, the catheter should be removed. If the relevant limb is subsequently adequately perfused, vascular assessment can be delayed until the patient's condition improves. However, if limb perfusion is inadequate, embolectomy should be attempted with a Fogarty catheter. If this is also inadequate, formal vascular assessment is required with a view to a vascular bypass procedure to re-establish flow. If there has been significant limb ischemia, a prophylactic fasciotomy may also be required in order to prevent compartment syndrome. If the patient is still dependent on IABP, the catheter should be inserted on the opposite side or in one of the other sites as mentioned previously.

Infection of the IABP catheter requires removal as well as antibiotic therapy. Balloon rupture is rare but leads to massive and fatal gas embolism. This is probably related to difficulty in insertion or damage of the balloon by atheroma at the site of insertion. Renal failure may result from renal artery embolization or because of renal hypoperfusion secondary to the poor circulation of the patient. It is controversial whether a properly functioning balloon placed close to the renal arteries can lead to renal failure.

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