title: Lower-extremity complications with femoral extracorporeal life support.
abstract: OBJECTIVE
  Patients undergoing emergency peripheral arteriovenous extracorporeal life support were evaluated for lower-extremity complications on the basis of the ipsilateral limb perfusion strategy.
  
  
  METHODS
  In a retrospective review of patients receiving extracorporeal life support (2008-2013), 105 of 250 underwent femoral extracorporeal life support. For ipsilateral lower-extremity perfusion, patients underwent no superficial femoral artery cannulation (n = 35), percutaneous superficial femoral artery cannulation (n = 23), or open superficial femoral artery cannulation (n = 47).
  
  
  RESULTS
  Patients' mean age was 50 ± 16 years, and 63% (n = 67) were male. A total of 92 patients (88%) had primary cardiac emergency, and 13 patients (12%) had cardiopulmonary emergency. The 30-day in-hospital mortality was 65% (n = 68), with an overall lower-extremity complication rate of 13% (n = 14). Lower-extremity complications were highest in the percutaneous superficial femoral artery (n = 6, 26%) and no superficial femoral artery (n = 7, 20%) groups (n = 1 [2%] in open superficial femoral artery group). In 2 group comparisons, the open superficial femoral artery group had significantly lower lower-extremity complications than the no superficial femoral artery (P = .02) and percutaneous superficial femoral artery (P = .004) groups. There was no difference between the no superficial femoral artery and percutaneous superficial femoral artery groups (P = .7). In the no superficial femoral artery group, emergency thromboembolectomy (n = 2), fasciotomy (n = 3), and emergency superficial femoral artery cannula placement (n = 2) were required. In the percutaneous superficial femoral artery group, thromboembolectomy with superficial femoral artery repair (n = 2), fasciotomy (n = 1), below-knee amputation (n = 1), open superficial femoral artery cannula revision (n = 1), and loss of distal signals from multiorgan failure (n = 1) were noted. In the open superficial femoral artery group, 1 patient had loss of signals from multiorgan failure.
  
  
  CONCLUSIONS
  No superficial femoral artery perfusion strategy is associated with a high lower-extremity complication rate. If percutaneous cannulation is performed, then angiographic confirmation of superficial femoral artery run-off is highly recommended. The open superficial femoral artery approach remains a safe alternative to the other strategies.
authors.affiliation: Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa. Electronic address: prashanth.vallabhajosyula@uphs.upenn.edu.
authors.forename: Prashanth
authors.initials: P
authors.lastname: Vallabhajosyula
authors.affiliation: Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Matthew
authors.initials: M
authors.lastname: Kramer
authors.affiliation: Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Sofiane
authors.initials: S
authors.lastname: Lazar
authors.affiliation: Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Fenton
authors.initials: F
authors.lastname: McCarthy
authors.affiliation: Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Rame
authors.affiliation: Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Joyce
authors.initials: J
authors.lastname: Wald
authors.affiliation: Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Wilson
authors.initials: W
authors.lastname: Szeto
authors.affiliation: Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Matthew
authors.initials: M
authors.lastname: Williams
authors.affiliation: Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Pavan
authors.initials: P
authors.lastname: Atluri
authors.affiliation: Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Nimesh
authors.initials: N
authors.lastname: Desai
authors.affiliation: Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Michael
authors.initials: M
authors.lastname: Acker
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007511:Ischemia / Q000209:etiology*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors