Feasibility and safety of total percutaneous closure of femoral arterial access sites after veno-arterial extracorporeal membrane oxygenation

Abstract

To evaluate the safety and efficacy of total percutaneous closure of the femoral artery access site after veno-arterial extracorporeal membrane oxygenation (VA-ECMO) with the Perclose ProGlide device.This retrospective observational study during an almost 2-year period included 21 patients who underwent VA-ECMO in whom the femoral artery puncture site was closed percutaneously with Perclose ProGlide devices. Technical success was defined as successful arterial closure of the common femoral artery, without the need for additional surgical or endovascular procedures. Access site complications were recorded at 24 hours and 30 days after arterial closure, such as major bleeding requiring transfusion or surgical intervention, minor bleeding, groin infection, pseudoaneurysm, and lymphocele.Technical success was achieved in 20 patients (95.2%). One patient required surgical repair for an access site pseudoaneurysm. Eighteen femoral arteries were closed with 2 devices each, while 3 patients required the use of a third device for femoral artery access site closure to achieve adequate hemostasis. No arterial thrombosis, arterial dissection, arterial stenosis, groin infection, or arteriovenous fistula occurred during the periprocedural period (within 24 hours of arterial closure) or during 30-day follow-up.Percutaneous closure with the Perclose ProGlide device is a feasible procedure for closing femoral arterial access sites after VA-ECMO, with a low incidence of access site complications.

Simulation training on bedside veno-arterial extracorporeal membrane oxygenation decannulation

“…The success rate remains higher than 85% with limited complications. Despite the number of reported good results, [1][2][3][4] open vascular repair rather than percutaneous closure remains the standard of practice. One of the main obstacles is the complex procedure and the long learning curve, especially for the low-volume ECMO centers.…”

“…One of these novel techniques is using post-close ProGlide device, and this was shown to be safe and could potentially save time and manpower. [1][2][3][4] Our group has modified and described the details of this technique in the literature. 5 The wounds are much smaller as compared with the conventional open repair and potentially, the chance of wound infection can be reduced.…”

“…The application of such technique, the success of percutaneous bedside closure, requires careful prior planning and technique training. 4 Moreover, being a percutaneous procedure when the arteriotomy wound is not under direct visualization, 100% successful decannulation rate is never achievable. The success rate was reported to be 71-100%.…”

“…The success rate was reported to be 71-100%. 4 Backup plans with vascular surgeons' standby are essential in case of failure of closure, so ensure safety of such a practice. Staffs in the ECMO centers need to be familiar with the preparation, the procedure as well as the device application technique for successful percutaneous closure.…”

Complete percutaneous decannulation from femoral venoarterial extracorporeal membrane oxygenation

“…Several centers have reported the use of percutaneous closure of arterial cannulation sites using suture closure systems, such as the Perclose ProGlide (Abbott Vascular, Santa Clara, Calif). 2 , 3 , 4 However, these systems generally require additional time to preclose the site before cannula insertion, which might not be ideal for rapidly declining patients. Furthermore, sutures from the closure system may be exposed to the environment in the period between insertion and decannulation, which could increase the risk of infection.…”