2009
DOI: 10.1016/j.jpedsurg.2008.09.010
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Percutaneous distal perfusion of the lower extremity after femoral cannulation for venoarterial extracorporeal membrane oxygenation in a small child

Abstract: Femoral cannulation in pediatric patients requiring extracorporeal membrane oxygenation (ECMO) is commonly associated with distal limb ischemia. Authors have previously reported successful lower limb perfusion using various open techniques to cannulate a distal lower extremity artery at the time of initial ECMO cannulation. These procedures include open femoral artery antegrade cannulation and distal posterior tibial artery retrograde cannulation in older children and adults. Such approaches require ample vess… Show more

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Cited by 33 publications
(31 citation statements)
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“…Although this decreases the neurologic complications of arterial cannula placement, it presents its own unique risks. The arterial cannula may obstruct forward flow to the limb, placing it at risk for ischemia and possible limb loss [3]. The exact incidence of limb ischemia is not known because it is not routinely recorded in the ELSO Registry.…”
Section: Introductionmentioning
confidence: 99%
See 1 more Smart Citation
“…Although this decreases the neurologic complications of arterial cannula placement, it presents its own unique risks. The arterial cannula may obstruct forward flow to the limb, placing it at risk for ischemia and possible limb loss [3]. The exact incidence of limb ischemia is not known because it is not routinely recorded in the ELSO Registry.…”
Section: Introductionmentioning
confidence: 99%
“…To relieve limb ischemia, distal perfusion catheters (DPCs), endovascular therapy, and femoral-to-femoral bypass grafts have been proposed [3,6,7]. However, many of these techniques are instituted after the development of ischemia.…”
Section: Introductionmentioning
confidence: 99%
“…3 Percutaneous approaches that have been described involve the placement (Seldinger technique) of an introducer sheath or a catheter in the ipsilateral femoral artery in an antegrade fashion distal to the site of ECMO cannulation. 4,5 The approach we describe carries several advantages to the earlier described techniques. Our technique is purely percutaneous and avoids surgical exposure, thus reducing potential complications such as infection.…”
Section: Discussionmentioning
confidence: 99%
“…These patients are critically ill, and relocation of the catheters in order to mitigate such symptoms can pose a formidable task. While various techniques have been described to reperfuse the limb without removal of the cannula, [1][2][3][4][5] these often involve open surgical exposure or percutaneous puncture of the artery at a site distal to the ECMO cannula. This can be difficult given the short length of the common femoral artery (CFA) and the presence of multiple other catheters in the vicinity.…”
Section: ¤ ¤mentioning
confidence: 99%
“…25 Lower extremity ischemia may be avoided by placement of a distal reperfusion cannula such as in the posterial tibial artery or the distal femoral artery. 26,27 Alternatively, a "stove pipe" end-to-side graft may be placed onto the femoral artery with the cannula placed into the end of the graft. 28 Thus, obstruction of the femoral artery is avoided, though this approach can be timeconsuming and technically demanding.…”
Section: Improvements In Technologymentioning
confidence: 99%