Vascular complications after extracorporeal membrane oxygenation (ECMO) Alessandro Grandi

Similar documents
Anatomical applicability of current off-the-shelf branched endografts in thoracoabdominal aortic aneurysms managed by open surgery.

Hybrid Procedures for Peripheral Obstructive Disease - Step by Step -

Ipsilateral Lower Extremity Complications in Patients Undergoing Emergent Common Femoral Arteriovenous ECMO Therapy

Percutaneous access and closure of the axillary artery during complex aortic endovascular procedures

Step by step Hybrid procedures in peripheral obstructive disease. Holger Staab, MD University Hospital Leipzig, Germany Clinic for Vascular Surgery

Subclavian Artery Plug Embolization (SAPE study): a real experience about endovascular subclavian occlusion prior to thoracic vascular repair

The Supera stent In retrograde vascular access for SFA ostium treatment: The SUPRA-FAST Registry

To ECMO Or Not To ECMO Challenges of venous arterial ECMO. Dr Emily Granger St Vincent s Hospital Darlinghurst NSW

Novel distal popliteal artery puncture technique in supine position for chronic femoropopliteal arterial occlusion; frontal popliteal puncture

Disclosure. I do not have any potential conflict of interest

How do I use mechanical debulking for the treatment of arterial occlusions

Redo treatment and open conversion after TEVAR

ISR-treatment The Leipzig experience with purely mechanical debulking. Sven Bräunlich Department for Angiology University-Hospital Leipzig, Germany

Wifi classification does not predict limb amputation risk in dialysis patients following critical limb ischemia revascularization

Fluoroscopy guided simultaneous distal perfusion as a preventive strategy of limb ischemia in patients undergoing extracorporeal membrane oxygenation

Catheter-Directed Thrombolysis for Acute Limb Ischemia. Hwan Jun Jae MD Seoul National University Hospital Seoul, Korea

Aggressive BTK Revascularization and Advanced Wound Care - Patient Specific Therapy Concepts

CHALLENGING ILIAC ACCESSES AND THROMBOSIS PREVENTION

The Subclavian Artery Access for difficult vascular interventions OGZ

Hybrid surgical treatment of bilateral aorto-femoral occlusion: a clinical case

3-year results of the OLIVE registry:

Reducing Thrombotic Burden in Arterial Interventions. Mario Galli, MD Cardiovascular Interventional Unit S. Anna Hospital, Como, Italy

The LIMBO trial: a RCT investigating adventitial dexamethasone infusion to prevent restenosis in BTK arteries utilizing a novel angiographic endpoint

The Crack and Pave technique for highly resistant calcified lesions. Manuela Matschuck MD University Hospital Leipzig Department Angiology

ECMO as a bridge to durable LVAD therapy. Jonathan Haft, MD Department of Cardiac Surgery University of Michigan

8th Emirates Cardiac Society Congress in collaboration with ACC Middle East Conference Dubai: October Acute Coronary Syndromes

Ultrasound Guidance during Arterial Access for Peripheral Vascular Intervention: A VSGNE Quality Improvement Project

SAVER: Rationale and merits for an all-comers DCB e-registry Frank Vermassen MD

PATIENT SPECIFIC STRATEGIES IN CRITICAL LIMB ISCHEMIA. Dr. Manar Trab Consultant Vascular Surgeon European Vascular Clinic DMCC Dubai, UAE

Drug-Coated Balloon Treatment for Patients with Intermittent Claudication: Insights from the IN.PACT Global Full Clinical Cohort

Comparison of carotid artery stenting results in primary stenosis and post-surgical restenosis

The Optimal Team for 24/7 CCU shock management

OMNIA case results: Lumee Oxygen measurements representative for CLI wound healing prognosis. M Werner 1 Feb 2018

The latest evidences from the DES trials in peripheral arterial disease

9/7/2018. Disclosures. CV and Limb Events in PAD. Challenges to Revascularization. Challenges. Answering the Challenge

THORACOABDOMINAL AORTIC ANEURYSMS HYBRID REPAIR

Chimney endovascular aneurysm sealing (ch-evas) for ruptured abdominal aortic aneurysms (AAA) due to type Ia endoleak following failed EVAS

Treatment Strategies for Long Lesions of greater than 20 cm

Importance of Thorough Vessel Preparation Followed By Anti- Restenotic Therapy: An Update from the DEFINITIVE AR Study

Puncture Ultrasound Guidance: Decrease Access Site Complications. Peter A. Schneider, MD Kaiser Foundation Hospital Honolulu, Hawaii

A new classification of the diabetic ischaemic foot promotes a modern approach to treatment. Michael Edmonds King s College Hospital London

Endovascular treatment of severe TASC C and D external iliac artery occlusive disease. SAINT-LEBES Bertrand Toulouse FRANCE

Clinical Outcomes Among Vascular Procedure Patients Receiving Suture-mediated vs Surgical Cutdown for Closure of Large-bore Arterial Access

Ted Feldman, M.D., MSCAI FACC FESC

Arterial Access for Diagnosis and Intervention T-Woei Tan, MD, FACS

The ZILVERPASS study a randomized study comparing ZILVER PTX stenting with Bypass in femoropopliteal lesions Preliminary report

PRISM Trial. Retrospective Case Review of Technical Success Using the Penumbra and Indigo Systems for Mechanical Thrombectomy in the Periphery

Use of distal perfusion in peripheral extracorporeal membrane oxygenation

Stents for The Common Femoral Artery: The Good, The Bad and The Ugly

Vascular screening in diabetic patients: how aggressive should we be and when to intervene?

Long-term Zilver PTX Data from Japan: 5-year Results in the Real World

Multisciplinary Team and Diabetic Foot Syndrome

Preliminary 6-month results of VMI-CFA trial

Retrograde dorsalis pedis and posterior tibial artery access after failed antegrade angioplasty

PATIENTS WITH CLI THE THREE YEARS OUTCOME OF ENDOLUMINAL BYPASS FOR PATIENTS WITH CLI

2-YEAR DATA SUPERA POPLITEAL REAL WORLD

The present status of selfexpanding. for CLI: Why and when to use. Sean P Lyden MD Cleveland Clinic Cleveland, Ohio

HYPOGASTRIC ARTERY PRESERVATION DURING EVAR: SURGICAL AND ENDOVASCULAR TECHNIQUES Single Centre Experience. Ilaria Ficarelli

The clinical outcome camparison between covered stent(cv) and drug-eluting balloon(deb) for SFA lesions: a single center result

Angiosome concept myth or truth? Does it make a real difference in real world cases?

Cardiogenic Shock. Dr. JPS Henriques. Academic Medical Center University of Amsterdam The Netherlands

5F Devices with 0.035

Is combination therapy with directional atherectomy followed by DCB the answer to challenges in treating SFA disease?

COMBINED TECHNIQUE CHIMNEY + FENESTRATED ENDOGRAFT FOR COMPLEX ANEURYSMS ERIC DUCASSE - MD PHD FEVBS CHU BORDEAUX

OCT Guided Atherectomy: Initial Results of the VISION Trial Using the Pantheris Catheter. Patrick Muck, MD

Jennifer A. Brown The Cleveland Clinic School of Perfusion Cleveland, Ohio

DECLARATION OF CONFLICT OF INTEREST

One Year after In.Pact Deep: Lessons learned from a failed trial. Prof. Dr. Thomas Zeller

Option and Pitfalls in Cannulation for Extracorporeal Support

The essentials for BTK procedures: wires, balloons, what else

Massimiliano Fusaro, MD on behalf of ISAR-STATH Investigators. Deutsches Herzzentrum München, Technische Universität München Munich - Germany

Extracorporeal Membrane Oxygenation (ECMO)

Objective assessment of CLI patients Hemodynamic parameters

Outcomes Of DCB Use In Real World Registries: 2 Year Results From The INPACT Global Registry

Algorithm for Managing Acute Lower Extremity Ischemia. Peter A. Schneider, MD Honolulu, Hawaii

LV Distension and ECLS Lungs

The Role of Lithotripsy in Solving the Challenges of Vascular Calcium. Thomas Zeller, MD

VIRTUS: Trial Design and Primary Endpoint Results

The ZILVERPASS study a randomized study comparing ZILVER PTX stenting with Bypass in femoropopliteal lesions

Cath Lab Essentials : LV Assist Devices for Hemodynamic Support (IABP, Impella, Tandem Heart, ECMO)

Cardiovascular Disease in CLI Patients

Open fenestration for complicated acute aortic B dissection

Combat Extremity Vascular Trauma

Distal hybrids - an option in long SFA CTO accompanied by severely compromized crural runoff

Cardioplegia Circuit Products { ANTEGRADE}

Mechanics of Cath Lab Support Devices

State of the Art of PEVAR

My personal experience with INCRAFT in standard and challenging cases

Mechanics of Cath Lab Support Devices

Lessons learnt from DES in the SFA is there any ideal concept so far?

Circulatory Support: From IABP to LVAD

Successful endovascular treatment for BTK lesion using wire rendezvous technique and retrograde knuckle wire technique by collateral approach

The Illumina FIH study with a next generation DES 12-months results

Update on the OPTIMIZE BTK Trial. Marianne Brodmann, MD Division of Angiology Medical University Graz, Austria

Endovascular Treatment of Type II Endoleak Following TEVAR for Thoracic Aortic Aneurysm: Squeeze Technique to Reach the Aneurysmal Sac

I Was Too Late With Device Placement

The Auckland Experience with the Nellix EVAS System. Andrew Holden, MBChB, FRANZCR

Clinical trial and real-world outcomes of an endovascular iliac aneurysm repair with the GORE Iliac Branch Endoprosthesis (IBE)

The relation of 2D perfusion angiography after BTK intervention and wound healing in patient with CLI - Single center prospective study -

Koen Keirse, MD RZ Tienen, Belgium

Transcription:

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

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

Vascular complications of ECMO Author (year) N Vasc. Surg.% Ischaemia % Amputation % Vascular complications Cheng (2014)* 1866 17 nr 4.3 account for 11-18% of Aziz (2014) 101 16 18 1 patients Bisdas (2011) 143 nr 11 1 Foley (2010) 43 4 16.2 1 *review

Vascular complications risk factors Anatomical issues PAD Multiple cannulation Emergency

Emergency scenario

How to face vascular injuries

Percutaneous cannulation Needle DUS guidance CFV CFA

Percutaneous cannulation Avoid WRONG cannulations Arterial cannula in CFV

Percutaneous closure device

Surgical cannulation 1. Multiple failed attempt of percutaneous cannulation 2. Previous surgery

Early diagnosis Lower limb ischemia diagnosis may be an issue: - Peripheral vasoconstriction - ECMO laminar flow - CPK and lactate in cardiac arrest

Antegrade perfusion Selective perfusion of the SFA in case of CFA extensive disease

Antegrade perfusion The major limitation is the introducer side-branch: NO more than 6Fr introducers

Post-cannulation DUS monitoring Without antegrade perfusion With antegrade perfusion Popliteal art. Popliteal art. laminar flow: 8 cm/sec laminar flow: 25 cm/sec

Fate of the contralateral limb Impella (12 Fr) Counterpulsation dev. (7 Fr)

Fate of the contralateral limb Bilateral antegrade perfusion

Surgical removal Prefer longitudinal incision (better vessels control) Direct suture always when possible Prefer GSV patch ( risk of infection)

OSR experience ECMO 2008-2016: 503 pts Respiratory Respiratory 93 Cardiac 211 18% 42% Cardiac Extracorp.Resusc. 199 40% Extracorp. resuscitation

OSR experience Extracorporeal resuscitation Other indications 140 105 70 35 0 2008 2010 2012 2014 2016

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)

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)

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

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

2024 © healthdocbox.com Privacy Policy | Terms of Service | Feedback