Intra-aortic balloon counterpulsation (IABC) has been a clinical modality since 1968. In the intervening years the patient population has become older, sicker and smaller. Modern balloon design permits the insertion of balloons into this evolving patient population and the balloon is increasingly threatened by the calcific plaque of the aging aorta and by the geometry of the shorter descending thoracic aorta in the smaller patient. Balloon sizing consideration and radiographic verification of balloon position within the aorta will reduce the incidence of balloon damage during IABC.
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