Intra-aortic balloon pumping (IABP) was recently performed during the perioperative period in seven patients in whom balloon insertion was difficult because of vascular complication. Prophylactic measures for the prevention of limb ischemia were taken when the balloon was inserted. These measures included (1) balloon insertion through the femoral artery and continuous infusion of heparin into the femoral artery in three patients, (2) balloon insertion through the left femoral artery and femoro-femoral arterial crossover bypass in two patients, and (3) balloon insertion through the left common iliac artery and axillo-femoral bypass on the same side in two patients. Most patients recovered satisfactorily without any evidence of ischemia of the limbs either clinically or in serum biochemistry examination. One patient died of prolonged cardiac failure.