Vascular complications after extracorporeal membrane oxygenation (ECMO) Alessandro Grandi
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1 Vascular complications after extracorporeal membrane oxygenation (ECMO) Alessandro Grandi Vascular Surgery, Vita-Salute - San Raffaele University Scientific Institute Ospedale San Raffaele, Milan Italy Chief: Prof. R. Chiesa
2 Disclosure Speaker name: Alessandro Grandi I have the following potential conflicts of interest to report: Consulting Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) I do not have any potential conflict of interest
3 Vascular complications of ECMO Author (year) N Vasc. Surg.% Ischaemia % Amputation % Vascular complications Cheng (2014)* nr 4.3 account for 11-18% of Aziz (2014) patients Bisdas (2011) 143 nr 11 1 Foley (2010) *review
4 Vascular complications risk factors Anatomical issues PAD Multiple cannulation Emergency
5 Emergency scenario
6 How to face vascular injuries
7 Percutaneous cannulation Needle DUS guidance CFV CFA
8 Percutaneous cannulation Avoid WRONG cannulations Arterial cannula in CFV
9 Percutaneous closure device
10 Surgical cannulation 1. Multiple failed attempt of percutaneous cannulation 2. Previous surgery
11 Early diagnosis Lower limb ischemia diagnosis may be an issue: - Peripheral vasoconstriction - ECMO laminar flow - CPK and lactate in cardiac arrest
12 Antegrade perfusion Selective perfusion of the SFA in case of CFA extensive disease
13 Antegrade perfusion The major limitation is the introducer side-branch: NO more than 6Fr introducers
14 Post-cannulation DUS monitoring Without antegrade perfusion With antegrade perfusion Popliteal art. Popliteal art. laminar flow: 8 cm/sec laminar flow: 25 cm/sec
15 Fate of the contralateral limb Impella (12 Fr) Counterpulsation dev. (7 Fr)
16 Fate of the contralateral limb Bilateral antegrade perfusion
17 Surgical removal Prefer longitudinal incision (better vessels control) Direct suture always when possible Prefer GSV patch ( risk of infection)
18 OSR experience ECMO : 503 pts Respiratory Respiratory 93 Cardiac % 42% Cardiac Extracorp.Resusc % Extracorp. resuscitation
19 OSR experience Extracorporeal resuscitation Other indications
20 OSR results Overall N= 503 (%) Cardiac resuscitation N= 199 (%) Peripheral cannulation 464 (92,2) 187 (94) Vascular complications 48 (9,5) 28 (14) Elective surgical removal 26 (5,1) 12 (6) Mortality 268 (53,2) 151 (75,8)
21 OSR results Vascular complications Overall N= 48 (%) Cardiac resuscitation N= 28 (%) Bleeding 29 (5,7) 17 (8,5) Lower limb ischemia 19 (3,7) 11 (5) Compartment syndrome 12 (2,3) 8 (4) Amputation 4 (0,7) 3 (1,5)
22 Conclusion Vascular complications after ECMO are not negligible Percutaneous DUS-guided cannulation Aggressive tailored antegrade perfusion Early diagnosis Early surgical revision in case of complications Crucial to improve results
23 Vascular complications after extracorporeal membrane oxygenation (ECMO) Alessandro Grandi Vascular Surgery, Vita-Salute - San Raffaele University Scientific Institute Ospedale San Raffaele, Milan Italy Chief: Prof. R. Chiesa
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Koen Keirse, MD RZ Tienen, Belgium
Clinical Benefits of the Vanguard IEP Peripheral Balloon Angioplasty System with Integrated Embolic Protection from the ENTRAP Study Koen Keirse, MD RZ Tienen, Belgium Disclosure Speaker name: Koen Keirse...