title: Vascular complications in patients undergoing femoral cannulation for extracorporeal membrane oxygenation support.
abstract: BACKGROUND
  Extracorporeal membrane oxygenation (ECMO) is a well-established treatment for severe cardiopulmonary failure. Patients undergoing ECMO support through femoral vessels are prone to vascular complications. The aim of this study was to evaluate such complications to outline basic technical principles for their prevention.
  
  
  METHODS
  From January 2005 to December 2009, 174 patients underwent ECMO support through cannulation of the femoral vessels. The primary outcome was any vascular complication. Secondary outcomes were 30-day mortality and 1-year survival. A logistic regression analysis including ECMO duration, peripheral arterial disease, ECMO access (percutaneous versus open), and diabetes mellitus identified predictors for vascular complications.
  
  
  RESULTS
  The venoarterial mode was used in 143 patients (82%), and venovenous in 31 patients (18%). Of the 17 (10%) observed vascular complications, 15 (88%) occurred in patients with venoarterial access, whereas 2 (12%) occurred after venovenous access (p=0.50) Two patients who had extremity ischemia required limb amputation. Thirty-day mortality and 1-year survival rates were 63% and 26%, respectively. Peripheral arterial disease was the only strong predictor of vascular complications (odds ratio, 6.95; 95% confidence interval, 1.89 to 25.59; p=0.003). Vascular complications were not associated with early or late mortality.
  
  
  CONCLUSIONS
  The incidence of vascular complications in venovenous cannulation was low, whereas in arterial cannulation, it is still considerable. Peripheral arterial disease remains a risk factor, and early involvement of vascular surgeons for open vascular exposure or alternative vascular access sites can be recommended. Vascular complications after ECMO support are not associated with higher mortality rates.
authors.affiliation: Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany. th.bisdas@gmail.com
authors.forename: Theodosios
authors.initials: T
authors.lastname: Bisdas
authors.forename: Gernot
authors.initials: G
authors.lastname: Beutel
authors.forename: Gregor
authors.initials: G
authors.lastname: Warnecke
authors.forename: Marius M
authors.initials: MM
authors.lastname: Hoeper
authors.forename: Christian
authors.initials: C
authors.lastname: Kuehn
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Omke E
authors.initials: OE
authors.lastname: Teebken
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D002423:Cause of Death; D015897:Comorbidity; D004617:Embolism / Q000209:etiology / Q000401:mortality; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D005263:Femoral Artery / Q000293:injuries*; D005268:Femoral Vein / Q000293:injuries*; D006801:Humans; D007511:Ischemia / Q000209:etiology* / Q000601:surgery; D053208:Kaplan-Meier Estimate; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000150:complications; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000401:mortality / Q000628:therapy*; D013927:Thrombosis / Q000209:etiology / Q000401:mortality; D055815:Young Adult