title: 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 vessel diameters to accommodate an arteriotomy and catheter insertion and, therefore, are of limited use in smaller children. We hypothesized that after femoral artery cannulation for ECMO, a percutaneous technique of distal limb perfusion might offer unique advantages when treating lower extremity ischemia in small pediatric patients. We report a technique for percutaneous antegrade cannulation in a 4-year-old patient shortly after her primary cannulation for venoarterial ECMO via the femoral artery.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, and Columbia University Medical Center, New York, NY 10032, USA. mjh2155@columbia.edu
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Haley
authors.forename: Jason C
authors.initials: JC
authors.lastname: Fisher
authors.forename: Alejandro R
authors.initials: AR
authors.lastname: Ruiz-Elizalde
authors.forename: Charles J H
authors.initials: CJ
authors.lastname: Stolar
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Morrissey
authors.forename: William
authors.initials: W
authors.lastname: Middlesworth
mesh_terms: D000465:Algorithms; D002404:Catheterization; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D005268:Femoral Vein; D006801:Humans; D007511:Ischemia / Q000209:etiology* / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D015424:Reperfusion