title: Percutaneous vascular cannulation for extracorporeal life support (ECLS): a modified technique.
abstract: OBJECTIVE
  Vascular access and cannulation are crucial issues to maximize the efficiency of extracorporeal circulation techniques and to preserve patients' safety. Techniques of cannulation have changed over the years, from surgical cutdown to percutaneous approaches, which are now considered standard practice. We describe an original modified percutaneous cannulation technique developed in our Department and we report our clinical experience and complications observed.
  
  
  METHODS
  A Seldinger technique utilizing 3 guidewires with passage of a dilator over each guidewire was used. Two concentric pursestring sutures, prepared before cannulation, minimize procedure-associated bleeding. Cannulation is performed under direct fluoroscopic control.
  
  
  RESULTS
  From 1997 to 2009, 38 patients (31 VV-ECLS, 7 VA-ECLS) have been cannulated using our technique, resulting in a total of 69 venous cannulations. Average external caliber of venous cannulae was 23 Fr (15-29 Fr). Mean duration of the entire cannulation procedure was 40 minutes (20-60 min). Adverse events occurred in 3 patients.
  
  
  CONCLUSIONS
  The technique described is safe and feasible and the incidence of procedure-related complications is very low, but it may require longer time to be performed.
authors.affiliation: Department of Perioperative Medicine and Intensive Care, San Gerardo Hospital, Monza, Italy. jaku71@virgilio.it
authors.forename: Giacomo
authors.initials: G
authors.lastname: Grasselli
authors.forename: Antonio
authors.initials: A
authors.lastname: Pesenti
authors.forename: Roberto
authors.initials: R
authors.lastname: Marcolin
authors.forename: Nicolò
authors.initials: N
authors.lastname: Patroniti
authors.forename: Stefano
authors.initials: S
authors.lastname: Isgró
authors.forename: Paola
authors.initials: P
authors.lastname: Tagliabue
authors.forename: Alberto
authors.initials: A
authors.lastname: Lucchini
authors.forename: Roberto
authors.initials: R
authors.lastname: Fumagalli
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation; D002408:Catheters, Indwelling; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D015641:Radiography, Interventional; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome