Document Detail


A simple technique to prevent limb ischemia during veno-arterial ECMO using the femoral artery: the posterior tibial approach.
MedLine Citation:
PMID:  22143092     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Lower extremity ischemia is common when the femoral artery is used for veno-arterial extracorporeal membrane oxygenation (VA ECMO). We describe a new technique to reperfuse the extremity. The ipsilateral posterior tibial artery is exposed via a small incision behind the medial malleolus. The vessel is cannulated in a retrograde fashion and connected to the arterial limb of the ECMO circuit. Thirty-six patients received a posterior tibial reperfusion cannula: average flow was 155.8 ml/min and increased over the initial 24 hours. Fifty-eight percent received the posterior tibial cannula within 6 hours of ECMO initiation and none sustained permanent lower extremity injury. Of the remaining 42%, three required amputation or developed permanent neurologic injury. Overall survival was 41%. Cannulation of the posterior tibial artery is a simple technique to reperfuse the lower extremity during VA ECMO. The cannula should be inserted within 6 hours of ECMO initiation to avoid irreversible ischemic damage.
Authors:
D J Spurlock; J M Toomasian; M A Romano; E Cooley; R H Bartlett; J W Haft
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2011-12-05
Journal Detail:
Title:  Perfusion     Volume:  27     ISSN:  1477-111X     ISO Abbreviation:  Perfusion     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-03-06     Completed Date:  2012-07-16     Revised Date:  2014-09-24    
Medline Journal Info:
Nlm Unique ID:  8700166     Medline TA:  Perfusion     Country:  England    
Other Details:
Languages:  eng     Pagination:  141-5     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Catheterization / methods
Child
Cohort Studies
Extracorporeal Membrane Oxygenation / adverse effects,  methods*
Femoral Artery / surgery*
Humans
Ischemia / etiology,  prevention & control*
Leg / blood supply*,  surgery
Middle Aged
Tibia / blood supply*,  surgery
Tibial Arteries / surgery*
Young Adult
Grant Support
ID/Acronym/Agency:
T32 HL076123/HL/NHLBI NIH HHS; T32HL076123/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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