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Ann Thorac Surg 1999;67:1217
© 1999 The Society of Thoracic Surgeons

Correspondence

The prevention of leg ischemia in femoral cannulation

Münacettin Ceviz, MDa, Ahmet Özyazicioglu, MDa, Hikmet Koçak, MDa

a Department of Cardiovascular Surgery, Atatürk University School of Medicine, 25240 Erzurum, Turkey

e-mail: ceviz{at}tr-net.net.tr

To the Editor

We read with interest the article by Vander Salm [1] on ischemia avoidance in femoral cannulation. Two years ago, my colleagues and I presented a different method at the Twenty-Seventh Annual Meeting of Cardiac Surgery [2]. Also, Hendrickson and Glower reported their experiences with a similar method [3]. Our study was carried out on 5 cases. The range of ages was 4 to 45 (mean 27) years. Of these cases, 3 were male and 2 were female. ECMO was applied on 4 patients because of postoperative cardiopulmonary insufficiency and on 1 because of ARDS. Of the patients with cardiopulmonary insufficiency, 3 were aorto coronary bypass grafting, 1 total correction of Tetralogy of Fallot. Another patient had postpneumonic ARDS. ECMO was performed by cannulation through the common femoral artery and vena. Cannulation was applied on 2 cases percutaneously and on 3 cases in open technique. Centrifugal pump was used in ECMO. The ischemia appeared on the leg. At this stage, no sufficient flow was observed by means of Doppler investigation. Then, femoral exploration was performed. Superficial femoral artery and vena were cannulated toward distal by suitable cannulae. The cannulated artery was perfused using a suitable line from the arterial exit of the oxygenator. Another suitable line was connected to the venous cannula, and venous blood was drained into the main venous line (Fig 1 ). On all of the patients, ischemia in leg recovered. A continuous flow was determined by Doppler on distal arteries of the leg. ECMO process on patients was applied for 48 to 120 (mean 65) hours. Two patients died from multisystem organ failure. Recovery was observed on the other patients. In these patients, ECMO was ended and cannulae were removed. Arteriotomy and venotomy in 2 patients were primarily sutured and in the other patient, saphenous patch was used. In the following measurements obtained on the leg, ischemia was not observed. Ankle-brachial index was determined to be >=1. Femoral infection did not develop.



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  		Fig 1. Distal perfusion and drainage in femoral cannulation.

 
As it can be seen, our patient’s cardiopulmonary bypass (CPB) time is longer than Vander Salm’s cases. As indicated by Vander Salm, this technique first requires sewing a graft onto the femoral artery, and for this reason it takes longer to initiate CPB. Additionally, it has some disadvantages, such as hemorrhage and increased infection risk. In our techniques, we do not use synthetic grafts. Because we perform transverse arteriotomy, we think that there is no need to use grafts. The patient on whom we used saphenous patch had atherosclerotic femoral artery. If the technique suggested by Vander Salm was used, the performance of vascular incision transversely and the primer suturing of arteriotomy by removing the whole graft after CBP could be thought.

Using our technique, it has been determined that the arterial and venous blood flow of the leg can easily be restored in any case of ischemia appearing on the extremity during CPB and ECMO.

References

  1. Vander Salm T.J. Prevention of lower extremity ischemia during cardiopulmonary bypass via femoral cannulation. Ann Thorac Surg 1997;63:251-252.[Abstract/Free Full Text]
  2. Ceviz M, Özyazicioglu A, Yekeler I, Basoglu A, Ate A, Koçak H. The prevention of peripheral ischemia occurring during ECMO (Poster) Twenty-Seventh Annual Meeting of Cardiac Surgery, London, GB 13–17 May 1996.
  3. Hendrickson S.C., Glower D.D. A method for perfusion of the leg during cardiopulmonary bypass via femoral cannulation. Ann Thorac Surg 1998;65:1807-1808.[Abstract/Free Full Text]

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Reply
Marc de Perrot, Marc Licker, and Anastase Spiliopoulos
Ann. Thorac. Surg. 1999 67: 1218. [Extract] [Full Text] [PDF]



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