title: A simple technique to prevent limb ischemia during veno-arterial ECMO using the femoral artery: the posterior tibial approach.
abstract: Lower extremity ischemia is common when the femoral artery is used for veno-arterial extracorporeal membrane oxygenation (VA ECMO). We describe a new technique to reperfuse the extremity. The ipsilateral posterior tibial artery is exposed via a small incision behind the medial malleolus. The vessel is cannulated in a retrograde fashion and connected to the arterial limb of the ECMO circuit. Thirty-six patients received a posterior tibial reperfusion cannula: average flow was 155.8 ml/min and increased over the initial 24 hours. Fifty-eight percent received the posterior tibial cannula within 6 hours of ECMO initiation and none sustained permanent lower extremity injury. Of the remaining 42%, three required amputation or developed permanent neurologic injury. Overall survival was 41%. Cannulation of the posterior tibial artery is a simple technique to reperfuse the lower extremity during VA ECMO. The cannula should be inserted within 6 hours of ECMO initiation to avoid irreversible ischemic damage.
authors.affiliation: Department of Surgery, University of Michigan Health System University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Spurlock
authors.forename: J M
authors.initials: JM
authors.lastname: Toomasian
authors.forename: M A
authors.initials: MA
authors.lastname: Romano
authors.forename: E
authors.initials: E
authors.lastname: Cooley
authors.forename: R H
authors.initials: RH
authors.lastname: Bartlett
authors.forename: J W
authors.initials: JW
authors.lastname: Haft
mesh_terms: D000293:Adolescent; D000328:Adult; D002404:Catheterization / Q000379:methods; D002648:Child; D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods*; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000517:prevention & control*; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D008875:Middle Aged; D013977:Tibia / Q000098:blood supply* / Q000601:surgery; D016909:Tibial Arteries / Q000601:surgery*; D055815:Young Adult