title: A Novel Technique of Subclavian Artery Cannulation for Venoarterial Extracorporeal Membrane Oxygenation.
abstract: OBJECTIVE
  The common femoral artery is the standard site for immediate vascular access when initiating adult venoarterial extracorporeal membrane oxygenation. However, this approach is fraught with problems such as femoral artery occlusion, distal limb ischemia, reperfusion injury resulting in compartment syndrome, retroperitoneal hemorrhage, thrombosis, embolization, and most importantly, pulmonary edema. Here, we show our preference of using the subclavian artery with a side graft as a different cannulation technique for outflow of extracorporeal membrane oxygenation, which can avoid complications associated with different access techniques.
  
  
  METHODS
  Between September 2013 and December 2014, our group established venoarterial extracorporeal membrane oxygenation via subclavian artery-percutaneous femoral vein cannulation in 11 patients (81.1% men). Mean age was 33 ± 11.1 years (range, 16-55 y).
  
  
  RESULTS
  For this technique, the subclavian artery was slung by retrotapes (Retract-o-Tape; Quest Medical Inc. Allen, TX, USA) proximally and distally before arteriotomy. An 8-mm polyethylene terephthalate (Dacron) graft was then sutured in "end-to-side" fashion. The proximal retrotape was removed, and the distal retrotape was passed through a snare. This maneuver allowed us to manage distal flow of subclavian artery by tightening this tape, thus avoiding complications associated with right arm hyperperfusion. After venoarterial extracorporeal membrane oxygenation was established, central venous pressure and lactate levels decreased, and improvements in arterial blood-gas parameters were maintained.
  
  
  CONCLUSIONS
  Our protocol for venoarterial extracorporeal membrane oxygenation cannulation uses the subclavian artery for arterial access and provides a safe and perhaps improved means for providing venoarterial extracorporeal membrane oxygenation support.
authors.affiliation: From the Department of Cardiovascular Surgery, Turkey Yuksek Ihtisas Hospital, Ankara, Turkey.
authors.forename: Umit
authors.initials: U
authors.lastname: Kervan
authors.forename: Sinan Sabit
authors.initials: SS
authors.lastname: Kocabeyoglu
authors.forename: Dogan Emre
authors.initials: DE
authors.lastname: Sert
authors.forename: Emre
authors.initials: E
authors.lastname: Aygün
authors.forename: Kemal
authors.initials: K
authors.lastname: Kavasoglu
authors.forename: Mehmet
authors.initials: M
authors.lastname: Karahan
authors.forename: Ertekin Utku
authors.initials: EU
authors.lastname: Unal
authors.forename: Mustafa
authors.initials: M
authors.lastname: Pac
mesh_terms: D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D011474:Prosthesis Design; D012039:Regional Blood Flow; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D011093:Polyethylene Terephthalates