摘要Axillary intra-aortic balloon pump (IABP)used has increased in the recent few yearsafter UNOs allocation system changes. IABP's design and counterpulsation mechanism is highly regarded for its safety profile, simplicity and relative ease in management and care. However, despite continuous innovative efforts, the potential for complications still exists. The Benchmark regis-try is widely regarded as the tool for monitoring the evolving practice of IABP. The most common com-plications reported are balloon perforation, bleed-ing, migration, limb ischemia. Despite continuous innovative efforts, the potential for complications still exists. We present a case that brings to light a life-threatening complication which can arise dur-ing utilization of a IABP in patients waiting for heart transplant. We demonstrate a case of IABP migra-tion and obstruction of the superior mesenteric art-ery causing severe abdominal pain secondary to bowel ischemia.