Alternative option for limb reperfusion cannula placement for percutaneous femoral veno-arterial ECMO

Perfusion ◽  
2021 ◽  
pp. 026765912110032
Author(s):  
Laszlo Göbölös ◽  
Maurice Hogan ◽  
Vivek Kakar ◽  
Nuno Raposo ◽  
Stefan Sänger ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Lower Limb ◽  
Standard Technique ◽  
Limb Ischemia ◽  
Insertion Point ◽  
Cardiorespiratory Failure ◽  
Limb Perfusion ◽  
Femoral Vessels ◽  
Va Ecmo ◽  
Central Cannulation

Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is an established last line support for severe, acute cardiorespiratory failure. In the case of VA ECMO, peripheral cannulation via the femoral vessels is often advantageous when compared with the alternative central cannulation, and is associated with better clinical outcomes. One of the specific potential complications of peripheral femoral arterial cannulation for ECMO, however, is ipsilateral distal lower limb ischemia; a consideration especially when cannulating the vessel directly, as distal limb perfusion is invariably compromised by an occlusive effect of the arterial cannula within the femoral artery. The gold standard technique for lower limb reperfusion is a separate size 6–7 Fr cannula inserted proximally into the femoral artery, just below the insertion point of the ECMO return cannula, and connected directly to the ECMO circuit so that the blood flow is also directed distally to perfuse the entire limb. This functions well whether the ECMO cannula has been placed percutaneously or by surgical cut-down. Although proximal femoral arterial placement of the reperfusion cannula is the established and preferred technique, there are many technical challenges which may preclude its placement. Local haematoma or bleeding post ECMO insertion, peripheral vascular disease, constricted vasculature in severely shocked patients, or patient obesity are all common reasons why placement of the proximal reperfusion cannula may be difficult, or impossible. In such instances, our retrograde perfusion technique may maintain limb perfusion and may even be limb saving for patients on VA ECMO support.

scholarly journals Vascular Complications of Lower Limb Ischemia in Patients with Femoral Venoarterial Extracorporeal Membrane Oxygenation

2020 ◽  
Vol 23 (3) ◽  
pp. E305-E309
Author(s):  
Xiaozu Liao ◽  
Zhou Cheng ◽  
Liqiang Wang ◽  
Binfei Li ◽  
Weizhao Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Artery ◽  
Lower Limb ◽  
Independent Risk Factor ◽  
Limb Ischemia ◽  
Peripheral Artery ◽  
Lower Limb Ischemia ◽  
Ischemia Group ◽  
Artery Disease ◽  
Va Ecmo

Background: Lower limb ischemia in patients with extracorporeal membrane oxygenation (ECMO) via femoral artery catheterization negatively affects patient mortality and survivors’ quality of life [Gulkarov 2020]. In this study, ECMO was established via femoral artery catheterization. This study aimed to identify the risk factors of lower limb ischemia to provide sufficient evidence for its prevention. Methods: All patients with venoarterial (VA) ECMO via femoral artery catheterization in Zhongshan People’s Hospital from January 2008 to November 2019 retrospectively were analyzed. Patients’ general information and ECMO-related information were obtained, and the main outcome variables were survival and discharge and intubation-related adverse events (limb ischemia and incision bleeding). Logistic regression analysis was used to determine the independent risk factors of limb ischemia in patients with VA ECMO. Results: A total of 179 (98 [54.7%] men and 81 [45.3%] women) eligible patients were included in this study. Moreover, a total of 90 patients (48.9%) had low cardiac output, 41 (22.3%) had acute myocardial infarction, and 33 (17.9%) had fulminant myocarditis. Eighty-six (48.04%) patients survived to hospital discharge, 36 (20.11%) had limb ischemia, and 42 (23.46%) had incision bleeding. Furthermore, the ECMO-assisted time was 114.23 ± 67.88 hours. There was no significant difference in age, sex, and Sequential Organ Failure Assessment score between the limb ischemia group and the non-limb ischemia group. Multivariate logistic regression analysis showed that peripheral artery disease (odds ratio, 27.12; 95% confidence interval, 5.614–130.96) was an independent risk factor of limb ischemia in patients with ECMO. Conclusion: Limb ischemia is a common complication in patients with VA ECMO, and peripheral artery disease is an independent risk factor of limb ischemia in patients with VA ECMO via femoral artery catheterization.

scholarly journals Surgical techniques for hemostasis in penetrating trauma to femoral artery

2016 ◽  
Vol 12 (1) ◽  
Author(s):  
Nazir Ahmad ◽  
Ashfaq Ahmad ◽  
Syed Tahir Ahmad Shah
Keyword(s):  
Femoral Artery ◽  
Vein Graft ◽  
Femoral Vein ◽  
Penetrating Trauma ◽  
Limb Ischemia ◽  
Arterial Injury ◽  
Skin Damage ◽  
Ischemia Time ◽  
Study Results ◽  
Femoral Vessels

Objectives: To analyse the efficacy of various operative procedures and factors affecting the outcome especially the effect of limb ischemia time in penetrating trauma to the femoral artery. Study Design: Prospective. Setting: Study was conducted at West Surgical Ward, Mayo Hospital Lahore. Duration: August 2001 to July 2004. Materials and Methods: All the patients >12 years of age referred from periphery as well as directly admitted with penetrating trauma to the femoral vessels alone or associated with other organ injuries having hard/soft physical signs of an arterial injury were included in the study. Results: 39(97.5%) patients were male, age ranged from 14-53 years with the mean limb ischemia time of 7.8 hours in the series. 35(87.5%) patients sustained firearm injuries. Superficial femoral artery was injured in 23(57.5%) followed by vein in 12(30%) and major vessels were found intact in 4(10%) patients. Lateral arteriorrhaphy was performed in 4(10%) & venorrhaphy in 3(7.5%) patients with 100 % succ ess rate, resection and primary anastomosis in 18(45%) patients with pseudo aneurysm formation in 1(2.5%) patient. Reverse great saphenous vein graft was interposed in 9(22.5%) patients with graft failure rate of 5% (2 patients). Femoral vein was ligated in 12(30%) patients with development of deep vein thrombosis in 2(5%) patients. There were 3(7.5%) deaths. No synthetic graft was used in the series. Conclusion: Exsanguination, prolonged injury duration, associated organ injuries and extensive soft tissue and skin damage of the extremities were the major factors responsible for increased morbidity particularly limb loss and mortality. Proximity of injury to the femoral vessels was a poor predictor of an arterial injury in the study. Arteriorrhaphy and primary end-to-end anastomosis are the main stays for an arterial injury repair, next comes the use of autogenous vein graft, in our setup. Moreover ligation of femoral vein is not associated with leg amputation.

scholarly journals POOR PROGNOSTIC DETERMINANTS FOR PATIENTS UNDERGOING SUPERFICIAL FEMORAL ARTERY ANGIOPLASTY

2020 ◽  
Vol 8 (11) ◽  
pp. 828-831
Author(s):  
S. Maruthu Thurai ◽  
◽  
P. Mohan Raja ◽  
M. Murali ◽  
◽  
...  
Keyword(s):  
Renal Insufficiency ◽  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Superficial Femoral Artery ◽  
Lower Limb ◽  
Prospective Observational Study ◽  
Negative Impact ◽  
Limb Ischemia ◽  
Limb Amputation ◽  
The Poor

Introduction: Aim is to study the poor prognostic determinants for patients undergoing superficial femoral artery angioplasty . Material and Methods: It is a Prospective observational study done in fifty patients who has undergone superficial femoral artery angioplasty for lower limb ischemia. Results: 22% had reocclusion of lesion, 10% required reintervention and 8% underwent major limb amputation .These three were considered major negative impact conditions. These were found in majority of patients with renal insufficiency, critical limb ischemia, smoker and drug defaulters. Conclusion: Thus poor prognostic determinants in the study were renal insufficiency, critical limb ischemia , smoker and drug defaulters.

Lower limb amputation following venous cannulation for VA-ECMO: a case report

Perfusion ◽  
2021 ◽  
pp. 026765912110506
Author(s):  
Natasha Habr ◽  
Jamal J Hoballah ◽  
Jamil Borgi ◽  
Caroline Hamadi ◽  
Pierre Sfeir ◽  
...  
Keyword(s):  
Lower Limb ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Venous Cannulation ◽  
Knee Amputation ◽  
Venous Cannula ◽  
Arterial Insufficiency ◽  
Va Ecmo

Lower limb amputation following arterial cannulation for VA-ECMO has been described in the literature. Limb ischemia however following venous cannulation is very rare and not quite understood. We present a case of limb ischemia following venous cannulation. A combination of venous congestion, compartment syndrome and subsequent arterial insufficiency is the proposed pathophysiology. Shock and use of vasopressors are compounding factors. Limb ischemia can be transient and reversible if diagnosed immediately and treated by early removal of the cannula. Our patient was unstable and ECMO dependent, and removal of the cannula was not an option. This resulted in limb loss and eventual above knee amputation. Use of the smallest appropriate venous cannula and early fasciotomy, in addition to hemodynamic optimization are measures that could help in preventing major amputation.

scholarly journals Hypertensive extracorporeal limb perfusion (HELP): A new technique for managing critical lower limb ischemia

2008 ◽  
Vol 48 (5) ◽  
pp. 1156-1165 ◽  
Author(s):  
Rodney J. Lane ◽  
Mark Phillips ◽  
Darryl McMillan ◽  
Matt Huckson ◽  
Samuel Wei-Unn Liang ◽  
...  
Keyword(s):  
Lower Limb ◽  
Limb Ischemia ◽  
New Technique ◽  
Lower Limb Ischemia ◽  
Limb Perfusion ◽  
A New Technique

scholarly journals Persistent Sciatic Artery Presenting With Right Lower Limb Ischemia: A Potential Sonographic Pitfall

2020 ◽  
Vol 5 (2) ◽  
pp. 1-4
Author(s):  
Venkatraman Bhat ◽  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Limb Ischaemia ◽  
Lower Limb Ischemia ◽  
Persistent Sciatic Artery ◽  
Lower Limb Ischaemia ◽  
Initial Imaging

A case of persistent sciatic artery is reported in a patient with the lower limb ischaemia. Initial imaging dopplar sonography suggested a possible occlusion of the superficial femoral artery.

scholarly journals Arterial embolectomy in lower limbs

1996 ◽  
Vol 114 (4) ◽  
pp. 1226-1230 ◽  
Author(s):  
Nelson Wolosker ◽  
Sérgio Kuzniec ◽  
Alvaro Gaudêncio ◽  
Luis Ricardo Amaral Salles ◽  
Ruben Rosoky ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Complication Rates ◽  
Fogarty Catheter ◽  
Vascular Surgeon ◽  
Limb Preservation ◽  
Muscle Tenderness ◽  
Repeated Surgery

Arterial embolisms in the lower limbs occur frequently, and are of great interest to the vascular surgeon. The authors studied 159 cases of arterial embolisms in lower limbs from January 1991 to July 1993. Ages varied from 12 to 98, with a mean of 58. Eighty patients were male and 78 were female. In most cases, etiology of the embolus was well-established, and mainly caused (78 percent) by atrial fibrillation. Occlusion was most frequent in the femoral artery (53.4 percent). All patients presented severe lower limb ischemia, but not gangrene, on admission. The duration of ischemia, between the onset of symptoms and the liberation of arterial flow, was in most patients (67.9 percent) less than 24 hours. All patients were submitted to lower limb embolectomy with the Fogarty catheter, of which 70.9 percent were done through the femoral artery. Fasciotomy was performed on 48 patients due to a compartimental syndrome. Nineteen patients died immediately after operation; 68.4 percent due to heart failure. Twenty-three (16.4 percent) of the 140 surviving patients (150 operated limbs) were submitted to amputations after the occlusion of artery branches, which had undergone embolectomies. One hundred and twenty-seven limbs (84.6 percent) were preserved in 117 patients (83.5 percent). Eleven cases (7.3 percent) required repeated surgery with the Fogarty catheter. The patients with muscle tenderness, paralysis, or ischemia lasting longer than 24 hours had worse results in relation to the preservation of the limb (p<0.05). We conclude that patients who present lower limb embolisms, are in good clinical condition, and who do not have any necrosis in the limbs, have good outcomes as to limb preservation, along with low complication rates, after embolectomy with the Fogarty catheter. Limb preservation was significantly higher in patients who did not present muscle tenderness, and who had normal motor activity and a ischemia duration of less than 24 hours.

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