J Korean Soc Radiol.  2016 Jun;74(6):373-379. 10.3348/jksr.2016.74.6.373.

Safety and Efficacy of Distal Perfusion Catheterization to Prevent Limb Ischemia after Common Femoral Artery Cannulation for Extracorporeal Membrane Oxygenation

• Jeon CH
• Seong NJ
• Yoon CJ

• KMID: 2164814
• DOI: http://doi.org/10.3348/jksr.2016.74.6.373

Abstract

PURPOSE
The extracorporeal membrane oxygenation (ECMO) cannula has the potential for obstructing flow to the lower limb, thus causing severe ischemia and possible limb loss. We evaluated the safety and clinical efficacy of percutaneous distal perfusion catheterization in preventing limb ischemia.
MATERIALS AND METHODS
Between March 2013 and February 2015, 28 patients with distal perfusion catheterization after ECMO were included in this retrospective study. The technical success was evaluated by Doppler ultrasound at the popliteal level after saline injection via distal perfusion catheter. Clinical success was assessed when at least one of the following conditions was met: restoration of continuous peripheral limb oximetry value or presence of distal arterial pulse on Doppler ultrasound evaluation or resolution of early ischemic sign after connecting the catheter with ECMO.
RESULTS
Twenty-six patients with early ischemia were successfully cannulated with a distal perfusion catheter (92.8%). Clinical success was achieved in 12/28 (42.8%) patients; 8/10 (80.0%) patients with survival duration exceeding 7 days and 4/18 (22.2%) patients with survival duration less than 7 days, respectively.
CONCLUSION
A percutaneous distal perfusion catheter placement was a feasible tool with safety and efficacy in preventing lower limb ischemia for patients with prolonged common femoral arterial cannulation for ECMO.

MeSH Terms

Catheterization*
Catheters*
Extracorporeal Membrane Oxygenation*
Extremities*
Femoral Artery*
Humans
Ischemia*
Lower Extremity
Oximetry
Perfusion*
Retrospective Studies
Spectrum Analysis
Treatment Outcome
Ultrasonography

Figure

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  Fig. 1 Continuous bedside tracing protocol for limb ischemia after common femoral artery cannulation for extracorporeal membrane oxygenation.

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  Fig. 2 63-year-old man with ST elevation myocardial infarction underwent venoarterial extracorporeal membrane oxygenation for cardiac arrest. A. On ultrasound image, a beveled needle tip (arrow) is placed into the anterior wall of the superficial femoral artery (*). B. Guidewire (arrowheads) is passed in the arterial lumen (*). C. 7 Fr distal perfusion catheter (arrows) is placed in the arterial lumen. Note a small-caliber of the SFA. SFA = superficial femoral artery

• 

  Fig. 3 Doppler ultrasonography at popliteal artery after saline injection through distal perfusion catheter. A. About 5 cc of saline is injected manually through distal perfusion catheter (arrow). B. On Doppler ultrasonography at popliteal artery (*), no demonstrable arterial flow is checked. C. On Doppler ultrasonography, antegrade flow is checked after saline injection through distal perfusion catheter.

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