Intra-aortic balloon pumps (IABPs) are commonly used circulatory support devices. Mesenteric ischemia is a serious and poorly studied complication of IABP use. Here, we examine six cases of mesenteric ischemia associated with IABPs from a single urban academic medical center. We examine patient, device, and radiographic characteristics, and hypothesize several mechanisms behind IABP-associated mesenteric ischemia including anatomic-to-device length mismatch, atheroembolism, and mechanical obstruction. We highlight the high morbidity and mortality of such complication and the need for future studies to examine risk factors that may predispose IABP-treated patients to the development of mesenteric ischemia.