title: Arterial injuries from femoral artery cannulation with port access cardiac surgery.
abstract: Although minimally invasive (MI) cardiac surgery reduces blood loss, hospital stay, and recovery time, some MI approaches require femoral arterial cannulation, which introduces a heretofore unknown risk of femoral arterial injury. This study was performed to examine the risk of femoral arterial injury after Port Access MI cardiac surgery (PA-MICS) with femoral cannulation. Data were prospectively obtained on 739 consecutive patients who had PA-MICS with femoral cannulation between June 1996 and April 2000, identifying any patient with new (<30 days postoperative) arterial insufficiency from the cannulation site. Patient characteristics (gender, age, height, weight, body surface area, smoking, peripheral vascular disease, diabetes) and operative variables (cannula size, cross-clamp time) were examined with univariate and multivariate analysis to identify risk factors for arterial injury. Injuries were defined and classified by radiologic and intraoperative assessment, and follow-up was obtained by patient examination and from the medical records. Femoral arterial occlusion (FAC) occurred in 0.68% (5/739) of patients (4 women, 1 man; age range 26-74 years). The risk of femoral injury was higher in women: 1.31% vs 0.23% (p = 0.07). One patient had intraoperative limb ischemia from iliofemoral dissection and was treated by axillopopliteal bypass. Four patients presented postoperatively with claudication. Three of these had iliofemoral arterial occlusion or localized iliofemoral dissection and were treated with iliofemoral bypass, and 1 patient had localized femoral artery stenosis treated by angioplasty. With a mean follow-up of 17.8 months (range 13-26 months) limb salvage was achieved in all patients. Secondary or tertiary interventions were required in 40% (2/5), both in patients with iliofemoral occlusion, and 1 patient (20% of femoral injuries, 0.135% of overall series) has chronic graft occlusion and long-term claudication. The risk of arterial injury after femoral arterial cannulation and perfusion for Port Access surgery was low (0.68%). This risk is increased in women and is unpredictable. Initial vascular repair has a significant failure rate, and secondary interventions are often necessary. Although the femoral cannulation and perfusion technique is safe overall, the risk must be clearly recognized.
authors.affiliation: Division of Vascular Surgery, New York University School of Medicine, 530 First Ave., New York, NY 10016, USA.
authors.forename: Bart E
authors.initials: BE
authors.lastname: Muhs
authors.forename: Aubrey C
authors.initials: AC
authors.lastname: Galloway
authors.forename: Michael
authors.initials: M
authors.lastname: Lombino
authors.forename: Michael
authors.initials: M
authors.lastname: Silberstein
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Grossi
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Colvin
authors.forename: Patrick
authors.initials: P
authors.lastname: Lamparello
authors.forename: Glenn
authors.initials: G
authors.lastname: Jacobowitz
authors.forename: Mark A
authors.initials: MA
authors.lastname: Adelman
authors.forename: Caron
authors.initials: C
authors.lastname: Rockman
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Gagne
mesh_terms: D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002404:Catheterization; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D005260:Female; D005263:Femoral Artery / Q000293:injuries*; D006801:Humans; D007083:Iliac Artery; D007383:Intermittent Claudication / Q000209:etiology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009203:Myocardial Infarction / Q000628:therapy; D011446:Prospective Studies; D013908:Thoracotomy