Which of the following are the most frequent complications of intra-aortic balloon counterpulsation?

B. Limb ischemia.

DISCUSSION: Stroke rarely occurs secondary to intra-aortic balloon pump use. The balloon must be positioned well below the aortic arch vessels and never proximal to the left subclavian artery origin. Strokes have been reported from emboli being thrown retrograde from the balloon; however, this is very rare. Limb ischemia is one of the most frequent complications of balloon pumping. The combination of iliofemoral atherosclerosis and catheter luminal obstruction may impede distal flow. This may require catheter removal to re-establish flow. In 2% to 10% of patients, arterial reconstruction is necessary to repair balloon-related complications. Smaller catheters have helped prevent limb ischemia. Arrhythmias in general are not complications of balloon pumping. In fact, arrhythmias related to ischemia may be controlled by the balloon pump. Aortic thrombosis can occur very rarely with pump use. A more frequent occurrence is distal embolization with limb ischemia. Patients should be heparinized while the balloon catheter is in place. Following cardiac surgery heparinization is usually delayed for 12 to 24 hours.