title: Comparison of Percutaneous Closure Versus Surgical Femoral Cutdown for Decannulation of Large-Sized Arterial and Venous Access Sites in Adults After Successful Weaning of Veno-Arterial Extracorporeal Membrane Oxygenation.
abstract: OBJECTIVE
  Surgical femoral cutdown for decannulation after veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is considered standard practice. However, access-site complications with this technique are not rare. The objective of this study is to evaluate feasibility, safety, and efficacy of a complete percutaneous decannulation procedure after VA-ECMO compared with the conventional surgical cutdown approach.
  
  
  METHODS
  In 35 patients who were successfully weaned from VA-ECMO support, femoral artery and vein access sites were closed using a completely percutaneous approach in 15 patients, whereas 20 patients had conventional surgical cutdown for access-site closure. Data concerning all 35 patients were collected retrospectively and analyzed regarding immediate vascular closure success, associated complications, and clinical outcomes.
  
  
  RESULTS
  Technical deployment success of the percutaneous vascular closure devices was achieved in all patients. Immediate success of closure was achieved more frequently in the surgical group (29% vs 100%; P<.05). Severe wound complications requiring surgery occurred only in the surgical group (0% vs 35%; P=NS). Surgical cutdown was associated with a significantly greater need for transfusion of packed red blood cells (1.6 ± 1.4 vs 2.2 ± 1.2; P<.05). Mean hospital stay was shorter in the percutaneous group (32 ± 18 days vs 36 ± 12 days; P=NS). One patient in the surgical group complained about sustained paresthesia after discharge.
  
  
  CONCLUSIONS
  Complete percutaneous closure of the femoral access site after VA-ECMO is feasible, effective, and safe when compared with conventional surgical closure and performed by experienced operators.
authors.affiliation: University of Leipzig, Heart Center, Department of Internal Medicine/Cardiology, Strümpellstrasse 39, 04289 Leipzig, Germany. nicolas.majunke@medizin.uni-leipzig.de.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Majunke
authors.forename: Norman
authors.initials: N
authors.lastname: Mangner
authors.forename: Axel
authors.initials: A
authors.lastname: Linke
authors.forename: Enno
authors.initials: E
authors.lastname: Boudriot
authors.forename: Sandra
authors.initials: S
authors.lastname: Erbs
authors.forename: Franziska
authors.initials: F
authors.lastname: Tietz
authors.forename: Sabrina
authors.initials: S
authors.lastname: Wolff
authors.forename: Stephan
authors.initials: S
authors.lastname: Schürer
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.forename: Marcus
authors.initials: M
authors.lastname: Sandri
mesh_terms: D000368:Aged; D002406:Catheterization, Peripheral / Q000379:methods*; D057186:Comparative Effectiveness Research; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005858:Germany; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000628:therapy; D016896:Treatment Outcome; D065506:Vascular Closure Devices