Sutureless Closure of Arterial Cannulation Sites

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> Percutaneous femoral cannulation for venoarterial extracorporeal membrane oxygenation (ECMO) is commonly performed but percutaneous removal of arterial cannulas has not been broadly accepted. We hypothesized that a system that allows endovascular access to ECMO circuits along with the MANTA<jats:sup>®</jats:sup> large-bore vascular closure device could be used to successfully close arterial ECMO cannulation sites in a large animal model. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Yorkshire swine (40 to 60 kg, n = 2) were used for this study. In the first swine, the infrarenal abdominal aorta was exposed. The aorta was cannulated once using a 15 Fr cannula and twice with a 19 Fr arterial cannula. A novel adaptor system that facilitates endovascular access to ECMO circuits was connected, and a 0.035″ Benston wire was placed through the adaptor and guided into the aorta. The cannula was removed over the wire and manual pressure was applied. The MANTA<jats:sup>®</jats:sup> sheath was inserted over the wire followed by the closure unit and was deployed. The process was repeated at 2 separate sites. A similar experiment was performed in a second swine, but through a median sternotomy to cannulate the ascending aorta. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Good hemostasis was achieved at all cannulation sites. Angiography demonstrated unobstructed flow across all closure sites with no evidence of extravasation. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> The data presented here support the use of the MANTA<jats:sup>®</jats:sup> vascular closure device for the closure of arterial cannulation sites following ECMO decannulation and demonstrates utility of a novel adaptor system for establishing endovascular access in this context. </jats:p></jats:sec>

Complete percutaneous decannulation from femoral venoarterial extracorporeal membrane oxygenation

“…We have previously shown excellent radiographic results after using the MANTA device to close arterial cannulation sites in a large animal model. 5 Case reports of successful use of the MANTA device in isolated cases of VA-ECMO decannulation have been reported recently. 13 , 14 , 15 Here we report the use of the MANTA device in 10 consecutive patients eligible for percutaneous decannulation.…”

“…The MANTA sheath was then inserted over the wire and pulled back to the deployment level (predetermined to be at least 1 cm farther than the measured depth of the arterial cannula). The MANTA was then deployed, as has been described previously 5 ( Video 1 ). Distal flow was confirmed by arterial pressure in the distal perfusion catheter and palpation or Doppler detection of distal extremity pulses.…”

“…CT ¼ computed tomography ECMO ¼ extracorporeal membrane oxygenation SFA ¼ superficial femoral artery VA ¼ venoarterial measured depth of the arterial cannula). The MANTA was then deployed, as has been described previously 5 (Video 1). Distal flow was confirmed by arterial pressure in the distal perfusion catheter and palpation or Doppler detection of distal extremity pulses.…”

“…In our center, we previously tested a large-bore vascular closure system, the MANTA vascular closure device (Teleflex, Morrisville, NC), in a large animal preclinical model and were able to successfully close ECMO arterial cannulation sites. 5 This device uses a bioresorbable anchor and collagen plug to close the arteriotomy. We hypothesized that we could use the MANTA to successfully close arterial ECMO cannulation sites in patients supported with VA-ECMO, with the additional use of a percutaneous closure device for removal of a distal perfusion catheter in the superficial femoral artery (SFA), which are placed routinely at the time of cannulation at our center.…”