Extracorporeal counterpulsation therapy is aortic balloon counterpulsation, mainly used for cardiogenic shock as well as intractable angina pectoris. The main hazard is the possibility of complications, and lower extremity ischemia is a common complication of aortic balloon counterpulsation, related to cardiac output, large catheter diameter, endothelial injury, and thrombus. When distal limb ischemia occurs, the balloon should be removed, the vessel repaired, the thrombus removed, and if necessary, the balloon repositioned in the appropriate location. Other vascular complications include occlusion of large vessel branches, such as distal ischemia due to occlusion of the renal, superior mesenteric, or subclavian arteries, and also include wound infection, pseudohematoma formation, and acute pancreatitis, with thrombocytopenia being a relatively rare complication. Although aortic balloon counterpulsation has the above-mentioned hazards, it still has a high clinical utility as a treatment modality to effectively improve coronary blood supply and reduce cardiac afterload.