Late vascular complications after extracorporeal membrane oxygenation support.
BACKGROUND
Extracorporeal membrane oxygenation support through the groin vessels is an established treatment option for patients with life-threatening conditions, resistant to medical treatment. However, because of critical status and type of vascular access, late vascular complications are a potential risk.


METHODS
From January 1998 through December 2004, 174 adults (mean age, 45 +/- 19 years) undergoing either cardiac surgery (n = 54, 31.4%) or lung transplantation (n = 120, 68.6%) were supported with extracorporeal membrane oxygenation. Data were prospectively collected and retrospectively analyzed. Follow-up extended up to 60 months (mean, 30 +/- 10 months). Multivariable regression analysis was used to identify predictors of late vascular complications.


RESULTS
Hospital survival was 57.3%. A total of 12 hospital survivors (12.2%) experienced late vascular complications. All late vascular complications were local stenosis at the former arterial cannulation site. Treatment was done by means of femorofemoral crossover bypass (n = 3), iliofemoral bypass (n = 1), thromboendarterectomy (n = 3), and percutaneous transluminal angioplasty (n = 5). We experienced no limb loss during follow-up. Predictors for long-term vascular complications were technical problems during extracorporeal membrane oxygenation explantation (p = 0.002; odds ratio, 23.2) and history of peripheral vascular disease (p = 0.015; odds ratio, 3.1).


CONCLUSIONS
Extracorporal membrane oxygenation support is associated with the development of late vascular complications at the femoral access site. In selected patients alternative cannulation sites should be considered.
Department of Cardiothoracic Surgery, Medical University Vienna, Vienna, Austria. daniel.zimpfer@meduniwien.ac.at
Daniel
D
Zimpfer
Birgit
B
Heinisch
Martin
M
Czerny
Thomas
T
Hoelzenbein
Sharok
S
Taghavi
Ernst
E
Wolner
Michael
M
Grimm
D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D014652:Vascular Diseases / Q000209:etiology* / Q000601:surgery / Q000628:therapy