title: Modified T-Graft for Extracorporeal Membrane Oxygenation in a Patient with Small-Caliber Femoral Arteries.
abstract: Extracorporeal membrane oxygenation (ECMO) is generally used as a last resort to provide cardiopulmonary support in patients whose advanced cardiac or respiratory failure does not respond to less invasive treatments. Lower-limb ischemia secondary to the large diameter of the arterial cannula is one of ECMO's major limitations: in patients who have small-caliber arteries, the cannulas can reduce native blood flow. The creation of a T-graft-a well-described technique to avoid limb ischemia-enables flow into the ECMO cannula without jeopardizing blood flow to the limb. However, leaving the graft exposed through an open groin wound can result in dislodgment, and it increases the risk of infection. We describe our modification of a conventional T-graft in an 18-year-old woman who had systolic heart failure, acute respiratory distress syndrome, and small-caliber femoral vessels. We tunneled a polytetrafluoroethylene graft inside a Dacron graft, then ran the combined graft through a subcutaneous tunnel similar to that created for a peripheral bypass. Thus, the graft was protected from environmental exposure and the risk of infection. Our technique seems safer and more secure than the original T-graft technique, and we recommend its consideration during ECMO cannulation.
authors.forename: Daniel
authors.initials: D
authors.lastname: Calderon
authors.forename: Aly
authors.initials: A
authors.lastname: El-Banayosy
authors.forename: Michael M
authors.initials: MM
authors.lastname: Koerner
authors.forename: Amy B
authors.initials: AB
authors.lastname: Reed
authors.forename: Faisal
authors.initials: F
authors.lastname: Aziz
mesh_terms: D000293:Adolescent; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D020878:Device Removal; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology / Q000601:surgery*; D054143:Heart Failure, Systolic / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D011474:Prosthesis Design; D020127:Recovery of Function; D012039:Regional Blood Flow; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Anastomosis, surgical; blood vessel prosthesis; extracorporeal membrane oxygenation/adverse effects/methods; femoral artery/surgery; ischemia/etiology/prevention & control; leg/blood supply; respiratory distress syndrome, adult/therapy; risk factors; treatment outcome; vascular surgical procedures/methods