Preclosing of the femoral artery allows total percutaneous venoarterial extracorporeal membrane oxygenation and prevents groin wound infection after lung transplantation

Abstract

OBJECTIVES In lung transplantation (LT), femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) usually requires an open approach that may be associated with severe groin wound infection. In endovascular aortic procedures, preclosing of the femoral artery (PFA) with vascular closure devices allows the percutaneous insertion and withdrawal of large-bore cannulae. We sought to evaluate whether this innovative technique could be applied in the specific setting of LT to achieve total percutaneous VA-ECMO and decrease groin wound infection. METHODS We conducted a retrospective study of a prospective database including patients who underwent LT in our centre from January 2011 to December 2017. Patients who underwent peripheral VA-ECMO using the PFA technique after January 2014 (PFA group, n = 106) were compared to those who underwent peripheral VA-ECMO using open cannulation and/or decannulation before January 2014 (non-PFA group, n = 48). The primary end point was the rate of technical success defined as total percutaneous VA-ECMO. Secondary end points included groin wound infections and delayed vascular complications. RESULTS The PFA technique was technically successful in 98 patients (92.5%). As compared with the non-PFA group, the PFA group was characterized by a similar rate of vascular complications (16.6% vs 11.3%, P = 0.360) and a decreased rate of groin wound infection (18.9% vs 0%, P < 0.001). In multivariate analysis, risk factors associated with vascular complications following PFA included female sex, peripheral arterial disease and ECMO duration. CONCLUSIONS In LT patients, PFA is associated with a high rate of total percutaneous VA-ECMO, thus preventing the occurrence of groin wound infection.

Axillary artery cannulation for veno-arterial extracorporeal membrane oxygenation support in cardiogenic shock

“…Cannulation wound complications are serious adverse outcomes that are associated with longer hospital stay, greater cost, and greater mortality, especially after heart transplantation due to immunosuppression, drug-induced diabetes, and preoperative low output status. 12 , 13 , 14 , 15 , 16 , 17 , 18 Salna and colleagues 15 reported that a cutdown procedure is a risk factor for developing FA wound complications in patients undergoing heart transplant. In the present study, arterial de-cannulation was performed by a cutdown technique, as we believed it would result in fewer vascular complications.…”

Complete percutaneous angio-guided approach using preclosing for venoarterial extracorporeal membrane oxygenation implantation and explantation in patients with refractory cardiogenic shock or cardiac arrest

“…Moreover, with the increase of structural heart disease interventions and large bore vascular accesses, this technique is now mastered by most of the interventional cardiologists. Preclosing has been studied by Pellenc et al in ECMO implanted prior to lung transplantation, with a dramatic reduction in the rate of groin wound infection as compared to open surgery [ 12 ]. The patients included in this study were however different from ours.…”

“…Regarding removal, surgical femoral cutdown is considered as standard practice but frequently associated with severe complications such as hemorrhage, delayed wound healing and infections [ 11 , 12 ]. Other techniques such as manual compression or post-closing using closing devices have been described but none of these are ideal [ 10 , 11 , 13 – 15 ].…”

Preclosure technique versus arterial cutdown after percutaneous cannulation for venoarterial extracorporeal membrane oxygenation

“…4,6,7 Further, in a previous study of the use of the preclosure technique in elective peripheral VA-ECMO before lung transplantation, similarly low rates of site infections were noted. 14 Historically, it has been typical to perform surgical vascular repair with exposure and repair of the common femoral artery at the time of decannulation from VA-ECMO. This open surgical procedure was associated with the risks of an open operation, related decreased patient mobility following its completion, and potential for seroma formation.…”