Kervan Umit, Kocabeyoglu Sinan Sabit, Sert Dogan Emre, Aygün Emre, Kavasoglu Kemal, Karahan Mehmet, Unal Ertekin Utku, Pac Mustafa
From the Department of Cardiovascular Surgery, Turkey Yuksek Ihtisas Hospital, Ankara, Turkey.
Exp Clin Transplant. 2017 Dec;15(6):658-663. doi: 10.6002/ect.2016.0002. Epub 2016 Oct 14.
The common femoral artery is the standard site for immediate vascular access when initiating adult venoarterial extracorporeal membrane oxygenation. However, this approach is fraught with problems such as femoral artery occlusion, distal limb ischemia, reperfusion injury resulting in compartment syndrome, retroperitoneal hemorrhage, thrombosis, embolization, and most importantly, pulmonary edema. Here, we show our preference of using the subclavian artery with a side graft as a different cannulation technique for outflow of extracorporeal membrane oxygenation, which can avoid complications associated with different access techniques.
Between September 2013 and December 2014, our group established venoarterial extracorporeal membrane oxygenation via subclavian artery-percutaneous femoral vein cannulation in 11 patients (81.1% men). Mean age was 33 ± 11.1 years (range, 16-55 y).
For this technique, the subclavian artery was slung by retrotapes (Retract-o-Tape; Quest Medical Inc. Allen, TX, USA) proximally and distally before arteriotomy. An 8-mm polyethylene terephthalate (Dacron) graft was then sutured in "end-to-side" fashion. The proximal retrotape was removed, and the distal retrotape was passed through a snare. This maneuver allowed us to manage distal flow of subclavian artery by tightening this tape, thus avoiding complications associated with right arm hyperperfusion. After venoarterial extracorporeal membrane oxygenation was established, central venous pressure and lactate levels decreased, and improvements in arterial blood-gas parameters were maintained.
Our protocol for venoarterial extracorporeal membrane oxygenation cannulation uses the subclavian artery for arterial access and provides a safe and perhaps improved means for providing venoarterial extracorporeal membrane oxygenation support.
在启动成人静脉 - 动脉体外膜肺氧合（ECMO）时，股总动脉是即刻建立血管通路的标准部位。然而，这种方法存在诸多问题，如股动脉闭塞、肢体远端缺血、再灌注损伤导致骨筋膜室综合征、腹膜后出血、血栓形成、栓塞，以及最重要的肺水肿。在此，我们展示了我们更倾向使用带侧支移植物的锁骨下动脉作为一种不同的ECMO流出道插管技术，这可以避免与不同通路技术相关的并发症。
在2013年9月至2014年12月期间，我们团队通过锁骨下动脉 - 经皮股静脉插管为11例患者（81.1%为男性）建立了静脉 - 动脉ECMO。平均年龄为33±11.1岁（范围16 - 55岁）。
对于该技术，在切开动脉前，用牵引带（Retract - o - Tape；美国德克萨斯州艾伦市Quest Medical公司）在近端和远端悬吊锁骨下动脉。然后以“端侧”方式缝合一段8毫米的聚对苯二甲酸乙二酯（涤纶）移植物。移除近端牵引带，将远端牵引带穿过圈套器。这一操作使我们能够通过收紧该牵引带来控制锁骨下动脉的远端血流，从而避免与右臂过度灌注相关的并发症。在建立静脉 - 动脉ECMO后，中心静脉压和乳酸水平下降，动脉血气参数持续改善。
我们的静脉 - 动脉ECMO插管方案使用锁骨下动脉作为动脉通路，为提供静脉 - 动脉ECMO支持提供了一种安全且可能更好的方法。
