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Jeon, Seong, and Yoon: Safety and Efficacy of Distal Perfusion Catheterization to Prevent Limb Ischemia after Common Femoral Artery Cannulation for Extracorporeal Membrane Oxygenation
Interventional Radiology
Original Article

Journal of the Korean Society of Radiology 2016; 74(6): 373-379.

Published online: 31 May 2016

DOI: https://doi.org/10.3348/jksr.2016.74.6.373

Safety and Efficacy of Distal Perfusion Catheterization to Prevent Limb Ischemia after Common Femoral Artery Cannulation for Extracorporeal Membrane Oxygenation

Chang Ho Jeon, MD1, Nak Jong Seong, MD1, Chang Jin Yoon, MD1, 2

1Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.

2Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.

Corresponding author: Nak Jong Seong, MD. Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea. Tel. 82-31-787-7608, Fax. 82-31-787-4070, nextblood@gmail.com

Received 14 June 2015       Revised 15 October 2015       Accepted 11 November 2015

Copyright © 2016 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The extracorporeal membrane oxygenation (ECMO) cannula has the potential for obstructing flow to the lower limb, thus causing severe ischemia and possible limb loss. We evaluated the safety and clinical efficacy of percutaneous distal perfusion catheterization in preventing limb ischemia.

Materials and Methods

Between March 2013 and February 2015, 28 patients with distal perfusion catheterization after ECMO were included in this retrospective study. The technical success was evaluated by Doppler ultrasound at the popliteal level after saline injection via distal perfusion catheter. Clinical success was assessed when at least one of the following conditions was met: restoration of continuous peripheral limb oximetry value or presence of distal arterial pulse on Doppler ultrasound evaluation or resolution of early ischemic sign after connecting the catheter with ECMO.

Results

Twenty-six patients with early ischemia were successfully cannulated with a distal perfusion catheter (92.8%). Clinical success was achieved in 12/28 (42.8%) patients; 8/10 (80.0%) patients with survival duration exceeding 7 days and 4/18 (22.2%) patients with survival duration less than 7 days, respectively.

Conclusion

A percutaneous distal perfusion catheter placement was a feasible tool with safety and efficacy in preventing lower limb ischemia for patients with prolonged common femoral arterial cannulation for ECMO.

Keywords: Extracorporeal Membrane Oxygenation, Ischemia, Perfusion, Catheter, Spectroscopy, Near-Infrared

Figures and Tables

Fig. 1

Continuous bedside tracing protocol for limb ischemia after common femoral artery cannulation for extracorporeal membrane oxygenation.

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Fig. 2

63-year-old man with ST elevation myocardial infarction underwent venoarterial extracorporeal membrane oxygenation for cardiac arrest.

A. On ultrasound image, a beveled needle tip (arrow) is placed into the anterior wall of the superficial femoral artery (*).
B. Guidewire (arrowheads) is passed in the arterial lumen (*).
C. 7 Fr distal perfusion catheter (arrows) is placed in the arterial lumen. Note a small-caliber of the SFA.
SFA = superficial femoral artery
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Fig. 3

Doppler ultrasonography at popliteal artery after saline injection through distal perfusion catheter.

A. About 5 cc of saline is injected manually through distal perfusion catheter (arrow).
B. On Doppler ultrasonography at popliteal artery (*), no demonstrable arterial flow is checked.
C. On Doppler ultrasonography, antegrade flow is checked after saline injection through distal perfusion catheter.
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Table 1

Technical and Clinical Success in Relation to Survival Duration

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Survival Less Than 7 Days Survival Exceed 7 Days Total Patients
Survival duration* 3 (1–6) 298 (24–591) 3 (1–591)
Technical success 16/18 (88.9) 10/10 (100) 26/28 (92.8)
Clinical success 4/18 (22.2) 8/10 (80.0) 12/28 (42.8)

Data are number of patients, and data in parenthesis are percentages except where indicated.

*Data are median and data in parenthesis are range.

Acknowledgments

This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health&Welfare, Republic of Korea (HI14C2175), Seoul National University Bundang Hospital Research Fund (No. 14-2014-018).
The authors thank the Medical Research Collaborating Center at Seoul National University Bundang Hospital for statistical analyses.

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