Ultrasound-guided closure of the femoral artery during venoarterial decannulation using a large-bore closure device

Tasnia Rahman; Johanna Herajärvi; Henri Ahonen; Mikko Jormalainen; Simo Syrjälä; Tommi Järvinen; Tatu Juvonen; Sebastian Dahlbacka

doi:10.1177/14574969231181232

Ultrasound-guided closure of the femoral artery during venoarterial decannulation using a large-bore closure device

Scand J Surg. 2023 Dec;112(4):256-264. doi: 10.1177/14574969231181232. Epub 2023 Jul 10.

Authors

Tasnia Rahman¹, Johanna Herajärvi^{2

3}, Henri Ahonen², Mikko Jormalainen², Simo Syrjälä², Tommi Järvinen², Tatu Juvonen^{2

3}, Sebastian Dahlbacka²

Affiliations

¹ Heart and Lung CenterUniversity of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Helsinki 00290, Finland.
² Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
³ Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland.

PMID: 37427753
DOI: 10.1177/14574969231181232

Abstract

Background: Peripheral femoro-femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) is viable for fast hemodynamic assistance during cardiogenic shock. Ultrasound-guided closure with a large-bore device (MANTA^®) is a feasible option potentially replacing surgical arteriotomy closure in peripheral VA-ECMO decannulation.

Methods: This retrospective study included patients weaning from percutaneously inserted femoro-femoral VA-ECMO at the Helsinki University Hospital, Finland in 2012-2020. The primary endpoints were access-site complications, a composite of hematomas/seromas/surgical site infections (SSIs), and the safety endpoint of vascular complications (VCs).

Results: A total of 100 consecutive percutaneously implanted and weaned VA-ECMO patients were stratified into two groups by decannulation strategy: percutaneous ultrasound-guided MANTA device (n = 21, 21.0%) or surgical approach (n = 79, 79.0%). The mean age of the cohort was 51 ± 13 years and females represented 25.0%. The technical success rate of the percutaneous ultrasound-guided MANTA technique was 95.2%. In multivariate analysis, surgical closure was associated with a higher incidence of combined access site hematomas/seromas/SSIs compared to percutaneous ultrasound-guided deployment of MANTA device (44.3% versus 9.5%, odds ratio (OR): 7.162, 95% confidence interval (CI): 1.544-33.222; p = 0.012). Similarly, access-site complications necessitating interventions were more frequent in the surgical closure group compared to US-MANTA (ultrasound-guided MANTA) group (26.6% versus 0.0%, p = 0.005). VCs were infrequent in both groups without any significant intergroup difference (p > 0.99).

Conclusions: Percutaneous ultrasound-guided MANTA closure of the femoral artery after VA-ECMO decannulation was associated with high technical success rate and low incidence of VCs. Compared to surgical closure, access-site complications were significantly less frequent, along with access-site complications necessitating interventions.

Keywords: Percutaneous arterial closure; VA-ECMO; ultrasound-guided vascular closure device; venoarterial extracorporeal membrane oxygenation.

MeSH terms

Adult
Catheterization, Peripheral* / methods
Female
Femoral Artery* / diagnostic imaging
Femoral Artery* / surgery
Hematoma / etiology
Humans
Middle Aged
Retrospective Studies
Seroma
Surgical Wound Infection
Treatment Outcome
Ultrasonography, Interventional