title: Vascular complications of intra-aortic balloon pump usage in coronary bypass surgery: 18 years of experience.
abstract: OBJECTIVE
  To evaluate the vascular complication incidence related to intra-aortic balloon pump usage during coronary bypass surgery and possible risk factors.
  
  
  METHODS
  The retrospective study was conducted at Uludog University Hospital, Turkey, and comprised 147 cases in which intra-aortic balloon pump was used during coronary artery bypass surgery between January 1994 and December 2011. Data was examined in terms of age, gender, diabetes mellitus, hypertension, smoking, peripheral vascular disease, pre-operative serum creatinine, history of congestive heart failure, left ventricular ejection fraction, previous infarction and cardiac functional capacity. Time, indication, treatment duration, technique of insertion and complications were recorded about the balloon insertion. Patients in whom peripheral vascular complication developed were evaluated with pulse examination, Doppler ultrasound and angiography. Logistic regression analyses were carried out with the purpose of determining the relation between pre-operative clinical variables and vascular complications and mortality.
  
  
  RESULTS
  Of the total, 105 (71%) were males and 42 (28%) were females. The overall mean age was 62.4 +/- 10.1 years. Besides, 16 (41%) cases had diabetes mellitus and 30 (20%) had peripheral artery disease. The mean Euroscore was 7.6 +/- 4.8. Intra-aortic balloon pump was inserted in 16 (10.8%) due to pre-operative high risk and in 75 (51%) cases due to hypotension being non-responsive to inotropes. Balloon catheter was placed with percutaneous technique in 141 (96%) cases and sheath wasn't used in 44 (29%). The balloon stayed for 2.9 +/- 2.1 days on average. Balloon rupture developed in 1 (0.6%) case. Mortality resulted in 58 (39%) cases. Euroscore (p=0.012), staying in hospital (p=0.005), low ejection fraction (p=0.018), hypertension existence (p=0.003) in multivariate logistic regression analyses were found significant in terms of affecting mortality. Duration of therapy (p<0.001), existence of sheath (p=0.002), and existence of peripheral vascular disease (p<0.001) were found significant as factors affecting the development of vascular complication.
  
  
  CONCLUSIONS
  Intra-aortic balloon pump provides mechanical circulation assistance during coronary artery surgery, but peripheral vascular system should be well evaluated in order to avoid vascular complications and the balloon catheter should be placed without the sheath if necessary. The duration of the therapy is a risk factor for the development of vascular complication.
authors.affiliation: Department of Cardiovascular Surgery, Balikesir University, School of Medicine, Balikesir, Turkey. kadirercan@yahoo.com
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Ercan
authors.affiliation: Department of Cardiovascular Surgery, Balikesir University, School of Medicine, Balikesir, Turkey.
authors.forename: Orcun
authors.initials: O
authors.lastname: Gurbuz
authors.affiliation: Sevgi Hospital, Balikesir, Turkey.
authors.forename: Arzu
authors.initials: A
authors.lastname: Ercan
authors.affiliation: Uludag University, School of Medicine, Bursa, Turkey.
authors.forename: Oktay
authors.initials: O
authors.lastname: Tuydes
authors.affiliation: Uludag University, School of Medicine, Bursa, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Bicer
authors.affiliation: Uludag University, School of Medicine, Bursa, Turkey.
authors.forename: Davit
authors.initials: D
authors.lastname: Saba
authors.affiliation: Acibadem Hospital, Bursa, Turkey.
authors.forename: Hayati
authors.initials: H
authors.lastname: Ozkan
mesh_terms: D000368:Aged; D001808:Blood Vessels / Q000293:injuries; D001026:Coronary Artery Bypass / Q000379:methods; D003925:Diabetic Angiopathies / Q000601:surgery; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors