Columbia University College of Physicians and Surgeons, New York, NY.
Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY.
J Vasc Surg. 2018 Feb;67(2):542-548. doi: 10.1016/j.jvs.2017.05.127. Epub 2017 Aug 16.
Venous-arterial extracorporeal membrane oxygenation (VA-ECMO) is a well-established therapy for refractory cardiopulmonary failure. Femoral cannulation offers a quick and effective means of providing circulatory support but is not without complication. Inflammation or lymphatic disruption at the site of cannulation can cause the formation of lymphoceles, leading to the patient's discomfort and possibly necessitating intervention. The purpose of this study was to evaluate the incidence of in-hospital lymphocele formation in VA-ECMO patients and to identify predictors for their development.
We conducted a single-center retrospective review of 192 patients who underwent femoral VA-ECMO insertion and subsequent decannulation from March 2007 to August 2016 for cardiogenic shock. Baseline demographics, risk factors, and cannulation strategies were examined. Groin lymphocele formation was assessed as the primary outcome.
Median age was 58 years (interquartile range, 48-67 years) with a median duration of support of 4 days (interquartile range, 2-6 days). Lymphocele formation was identified in 31 patients (16%). Patients who developed lymphoceles were more likely to have post-heart transplantation primary graft dysfunction (PGD) as an indication for ECMO support compared with those who did not (54.2% vs 8%; P < .001). ECMO duration was similar between groups, but lymphocele patients were more likely to have undergone femoral cutdown procedures (68% vs 42%; P = .010). Compared with those PGD patients who did not develop lymphoceles, PGD lymphocele patients had higher rates of diabetes mellitus preoperatively (62% vs 8%; P = .006). Thirteen (42%) patients required surgical incision and drainage, and 4 of these patients (31%) required repeated surgical intervention.
Lymphocele formation is relatively common after femoral VA-ECMO. There was a significantly higher incidence of lymphocele formation in diabetic patients requiring support for PGD after heart transplantation.
静脉-动脉体外膜肺氧合（VA-ECMO）是治疗难治性心肺衰竭的一种成熟疗法。股动脉插管提供了一种快速有效的循环支持手段，但并非没有并发症。插管部位的炎症或淋巴破坏会导致淋巴囊肿的形成，导致患者不适，并可能需要干预。本研究旨在评估 VA-ECMO 患者住院期间淋巴囊肿形成的发生率，并确定其发生的预测因素。
我们对 2007 年 3 月至 2016 年 8 月期间因心源性休克接受股动脉 VA-ECMO 插入和随后拔管的 192 例患者进行了单中心回顾性研究。检查了基线人口统计学、危险因素和插管策略。股疝淋巴囊肿形成被评估为主要结局。
中位年龄为 58 岁（四分位距，48-67 岁），中位支持时间为 4 天（四分位距，2-6 天）。31 例（16%）患者发现淋巴囊肿形成。与未发生淋巴囊肿的患者相比，发生淋巴囊肿的患者更有可能因心脏移植后原发性移植物功能障碍（PGD）而需要 ECMO 支持（54.2% vs 8%；P<0.001）。两组 ECMO 持续时间相似，但淋巴囊肿患者更有可能接受股动脉切开术（68% vs 42%；P=0.010）。与未发生淋巴囊肿的 PGD 患者相比，发生淋巴囊肿的 PGD 患者术前糖尿病患病率更高（62% vs 8%；P=0.006）。13 例（42%）患者需要手术切开引流，其中 4 例（31%）患者需要重复手术干预。
股动脉 VA-ECMO 后淋巴囊肿形成较为常见。心脏移植后因 PGD 而需要支持的糖尿病患者淋巴囊肿形成的发生率明显更高。
