Interventional Closure of the Femoral Artery Access Site after Percutaneous Venoarterial ECMO: The Aachen Experience

Objectives: Removal of the arterial cannula after percutaneously inserted veno-arterial ECMO has its relatively common complications like hemorrhage, lower limb ischemia and especially wound healing problems. The Manta (Teleflex, NC, USA) system, a collagen-based vessel closure device (VCD), has been developed for the closure of large-bore arteriotomies.

Methods: We evaluated our outcomes using the MANTA VCD for interventional removal of the femoral artery (FA) ECMO cannula during the last year. The Manta VCD does not require additional steps during ECMO implantation. A custom-made Y-sheath (Freelife, Aachen, Germany) was used for the procedure in the arterial line. Femoral artery was cannulated with a 19-Fr (n = 6) or 21-Fr (n = 2) cannula. Distal limb perfusion routinely was maintained with an 8.5-Fr cannula. All interventional procedures were performed in the Cath-Laboratory or the hybrid OR. CT or Ultrasound evaluation was performed to estimate the skin-artery distance before the procedure. In brief, a stiff wire was inserted into the arterial cannula and served as a guidance to place the Manta system. The whole procedure was visualized by fluoroscopy and angiography. The arterial cannula was removed while wire access was maintained. An 18-Fr Manta device was inserted over the wire and retracted to the release level. The access for the limb perfusion cannulas were closed with a ProGlide device (Abbott Vascular, Santa Clara, CA).

Result: Eight patients with percutaneous femoral VA-ECMO were successfully weaned from the ECMO and the arterial cannula was percutaneously decannulated using the MANTA VCD. In All cases no Bleeding complication did occur. Primary success rate was 6 of 8 (75%). Two patients developed a vascular obstruction at the access site and required direct surgical intervention. In these two cases a more lateral arterial access was noted, but prompt vascular revisions were uneventfully. During follow-up, the six patients with successful percutaneous decannulation did not develop any vascular-, bleeding- or infectious complications and could be mobilized quickly.

Conclusion: Interventional femoral artery closure after percutaneous VA ECMO exhibits good primary success and thereby avoids serious complications. The continuous visualization provides a direct detection of intervention failure. Further experience with large patients' cohort is required.

Publication History

Article published online:
19 February 2021