Department of Surgery, Division of Pediatric Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287.
Department of Surgery, Division of Pediatric Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287.
J Pediatr Surg. 2020 Jul;55(7):1409-1413. doi: 10.1016/j.jpedsurg.2020.02.055. Epub 2020 Mar 5.
Decannulation from pediatric veno-arterial extracorporeal membrane oxygenation (VA-ECMO) involves the removal of large arterial perfusion cannulas from relatively small lower extremity arteries. While these challenging repairs are frequently performed by general pediatric surgeons, there is little standardization with regard to vascular techniques within the pediatric surgery training paradigm, resulting in variability in the repair of these arteriotomies and potential future consequences for lower extremity perfusion and growth. Herein we present a technique for repair of large common femoral arteriotomies following removal of ECMO perfusion cannulas utilizing a dual-layer patch of ipsilateral saphenous vein harvested via the arterial cutdown incision. This vein segment is everted to maximize endothelial surface area of the patch and dual layered to provide additional support against aneurysmal degeneration. The described technique is an effective repair of arteriotomy following VA-ECMO decannulation, which minimizes vascular complications and is an accessible technique to those without advanced vascular surgical training. LEVEL OF EVIDENCE: Level IV; operative technique description with small case series.
小儿静脉-动脉体外膜肺氧合（VA-ECMO）脱管包括从相对较小的下肢动脉中取出大的动脉灌注插管。虽然这些具有挑战性的修复通常由普通儿科外科医生进行，但儿科外科学培训模式中关于血管技术几乎没有标准化，导致这些血管切开术的修复存在差异，并可能对下肢灌注和生长产生潜在的未来后果。在此，我们介绍了一种在 ECMO 灌注插管移除后，使用通过动脉切开切口采集的同侧大隐静脉的双层补丁来修复大的股总动脉切开术的技术。将该静脉段外翻以最大限度地增加补丁的内皮表面积，并将其双层化以提供额外的支持，防止动脉瘤样变性。所描述的技术是 VA-ECMO 脱管后血管切开术的有效修复方法，可最大限度地减少血管并发症，并且对于没有高级血管外科培训的人来说，也是一种可行的技术。证据水平：IV 级；小型病例系列的手术技术描述。
