A simple technique to prevent limb ischemia during veno-arterial ECMO using the femoral artery: the posterior tibial approach

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Lower extremity ischemia is common when the femoral artery is used for veno-arterial extracorporeal membrane oxygenation (VA ECMO).We describe a new technique to reperfuse the extremity. The ipsilateral posterior tibial artery is exposed via a small incision behind the medial malleolus.The vessel is cannulated in a retrograde fashion and connected to the arterial limb of the ECMO circuit.

Thirty-six patients received a posterior tibial reperfusion cannula: average flow was 155.8 ml/min and increased over the initial 24 hours. Fifty-eight percent received the posterior tibial cannula within 6 hours of ECMO initiation and none sustained permanent lower extremity injury. Of the remaining 42%, three required amputation or developed permanent neurologic injury. Overall survival was 41%.

Cannulation of the posterior tibial artery is a simple technique to reperfuse the lower extremity during VA ECMO.The cannula should be inserted within 6 hours of ECMO initiation to avoid irreversible ischemic damage.

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