Long-term use of an intra-aortic balloon pump is often necessary for patients with severe left ventricular dysfunction who are awaiting cardiac transplantation. Complications caused by prolonged bed rest and immobility can occur when the traditional femoral approach is used for insertion of the balloon catheter. Insertion of the intra-aortic balloon catheter through the iliac artery is an alternative technique that allows patients to sit, stand, and walk while receiving counterpulsation. This approach is now being used to prevent the complications of immobility in patients awaiting cardiac transplantation. In this article, the special considerations, potential complications, and nursing interventions unique to the iliac artery approach are delineated.