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Frequency of long-term lower limb ischemia associated with intraaortic balloon pump use
1Medical-Surgical Nursing Program, Yale University School of Nursing, New Haven, Connecticut 06536-0740.
Insights
Long-term lower limb ischemia affects 18% of patients after intraaortic balloon pump (IABP) use. Acute ischemia, cardiogenic shock, and smoking are key risk factors for developing this complication post-IABP.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Medical Device Complications
Background:
- Lower limb ischemia is a known complication of intraaortic balloon pump (IABP) therapy.
- While acute complications are documented, long-term ischemic sequelae remain less understood.
- A growing number of patients survive IABP use and resume active lives, necessitating an understanding of persistent risks.
Purpose of the Study:
- To prospectively evaluate the incidence, characteristics, progression, and predisposing factors of long-term lower limb ischemia in patients treated with IABP.
- To identify specific risk factors associated with the development of persistent limb ischemia following IABP counterpulsation.
Main Methods:
- Prospective study of 151 patients previously treated with IABP.
- Clinical interviews and lower extremity examinations conducted 12 to 20 months post-IABP.
- Logistic regression analysis to identify risk factors for long-term limb ischemia.
Main Results:
- 18% of evaluated patients experienced limb ischemia, primarily characterized by discomfort and diminished pulses.
- Ischemia worsened over time in 14% of affected patients.
- Significant risk factors identified: prior acute limb ischemia (OR 8.89), cardiogenic shock indication for IABP (OR 3.59), and smoking history (OR 2.87).
Conclusions:
- Long-term lower limb ischemia is a significant concern for patients following IABP therapy.
- Patients with a history of acute limb ischemia, cardiogenic shock, or smoking are at higher risk.
- Awareness of these persistent complications is crucial for managing patients post-IABP discharge.
Abstract:
Lower limb ischemia is a frequent complication of intraaortic balloon pump (IABP) use. The incidence and risk factors for acute ischemia have been well-defined, but little is known about long-term ischemic complications. This prospective study evaluated the incidence, nature, progression and predisposing factors for long-term lower limb ischemia in 151 patients who were previously treated with the IABP. These persons were interviewed and their lower extremities examined 12 to 20 months after undergoing IABP counterpulsation. Limb ischemia, characterized primarily by ipsilateral discomfort and diminished pulses, occurred in 18% of those evaluated. Evidence of ischemia worsened over time in 14%. Logistic regression analysis, which was based on variables found to be significant in bivariate analysis, revealed that the occurrence of limb ischemia acutely, cardiogenic shock as an indication for IABP insertion, and smoking (at the time of hospitalization or having quit < 10 years previously) were risk factors for long-term lower limb ischemia. The adjusted odds ratio for acute limb ischemia was 8.89 (95% confidence interval 2.80 to 28.21), for cardiogenic shock 3.59 (95% confidence interval 1.01 to 12.75), and for smoking 2.87 (95% confidence interval 1.10 to 7.46). Increasing numbers of patients are undergoing IABP counterpulsation and a greater proportion of these are surviving their acute event and resuming active lives. It is essential to recognize that detrimental consequences of this device can persist long after hospitalization.