Percutaneous decannulation of extracorporeal membrane oxygenation using a plug-based closure device.
MANTA
vascular closure device
venoarterial extracorporeal membrane oxygenation
Journal
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
ISSN: 1522-726X
Titre abrégé: Catheter Cardiovasc Interv
Pays: United States
ID NLM: 100884139
Informations de publication
Date de publication:
05 2022
05 2022
Historique:
revised:
08
01
2022
received:
08
12
2021
accepted:
10
01
2022
pubmed:
24
1
2022
medline:
18
5
2022
entrez:
23
1
2022
Statut:
ppublish
Résumé
There is limited experience of using the MANTA plug-based vascular closure device for percutaneous arterial closure of the femoral artery after venoarterial extracorporeal membrane oxygenation. To study femoral artery complications and need for subsequent vascular interventions after percutaneous decannulation of venoarterial extracorporeal membrane oxygenation (VA ECMO) using the MANTA plug-based vascular closure device. We studied 34 consecutive patients who underwent percutaneous decannulation of VA ECMO using the MANTA device. Primary outcomes were conversion to surgical cutdown of the groin at decannulation (immediate) or later. Secondary outcomes were type of vascular complication necessitating conversion to surgical cutdown of the groin. Six (17.7%) patients had to undergo immediate (n = 3) or late (n = 3) conversion to surgical cutdown of the groin. Of these, three were owing to occlusion of the common femoral artery resulting in insufficient distal perfusion and three owing to bleeding or pseudoaneurysm. The mechanism of failure was complete intravascular deployment of the MANTA device in three patients, incomplete MANTA sealing of the arteriotomy in one patient, MANTA-unrelated thrombotic occlusion in one patient, and unknown in one patient. Surgical cut-down was typically performed with concomitant catheter thrombectomy with or without patch reconstruction of the artery. Percutaneous decannulation of VA ECMO using the MANTA VCD was feasible but a substantial number of patients needed to be converted to unplanned surgical repair, owing to either closure site-located stenosis/occlusion or bleeding. If suboptimal MANTA positioning is suspected, a low threshold for conversion to surgical cutdown of the groin is recommended.
Sections du résumé
BACKGROUND
There is limited experience of using the MANTA plug-based vascular closure device for percutaneous arterial closure of the femoral artery after venoarterial extracorporeal membrane oxygenation.
OBJECTIVES
To study femoral artery complications and need for subsequent vascular interventions after percutaneous decannulation of venoarterial extracorporeal membrane oxygenation (VA ECMO) using the MANTA plug-based vascular closure device.
METHODS
We studied 34 consecutive patients who underwent percutaneous decannulation of VA ECMO using the MANTA device. Primary outcomes were conversion to surgical cutdown of the groin at decannulation (immediate) or later. Secondary outcomes were type of vascular complication necessitating conversion to surgical cutdown of the groin.
RESULTS
Six (17.7%) patients had to undergo immediate (n = 3) or late (n = 3) conversion to surgical cutdown of the groin. Of these, three were owing to occlusion of the common femoral artery resulting in insufficient distal perfusion and three owing to bleeding or pseudoaneurysm. The mechanism of failure was complete intravascular deployment of the MANTA device in three patients, incomplete MANTA sealing of the arteriotomy in one patient, MANTA-unrelated thrombotic occlusion in one patient, and unknown in one patient. Surgical cut-down was typically performed with concomitant catheter thrombectomy with or without patch reconstruction of the artery.
CONCLUSION
Percutaneous decannulation of VA ECMO using the MANTA VCD was feasible but a substantial number of patients needed to be converted to unplanned surgical repair, owing to either closure site-located stenosis/occlusion or bleeding. If suboptimal MANTA positioning is suspected, a low threshold for conversion to surgical cutdown of the groin is recommended.
Identifiants
pubmed: 35067004
doi: 10.1002/ccd.30096
pmc: PMC9541842
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1945-1952Subventions
Organisme : Mr. Fredrik Lundberg (Donation)
Informations de copyright
© 2022 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.
Références
J Vasc Surg. 2016 Apr;63(4):998-1003.e1
pubmed: 26826058
Thorac Cardiovasc Surg. 2021 Sep;69(6):537-541
pubmed: 34376000
Multimed Man Cardiothorac Surg. 2020 Dec 22;2020:
pubmed: 33399283
Ann Thorac Surg. 2020 Jul;110(1):85-91
pubmed: 31794742
Eur Heart J Acute Cardiovasc Care. 2020 Jun;9(4):342-347
pubmed: 32363881
Ann Thorac Surg. 2020 Oct;110(4):e307-e309
pubmed: 32145194
Circ Cardiovasc Interv. 2019 Jul;12(7):e007258
pubmed: 31296082
J Vasc Surg. 2018 Feb;67(2):542-548
pubmed: 28822659
J Am Coll Cardiol. 2019 Feb 19;73(6):698-716
pubmed: 30765037
JACC Cardiovasc Interv. 2019 Dec 23;12(24):2564-2566
pubmed: 31857032
Semin Thromb Hemost. 2020 Feb;46(1):62-72
pubmed: 31858515
JTCVS Tech. 2020 Nov 21;6:75-81
pubmed: 34318149
Cardiovasc Revasc Med. 2022 Jan;34:75-79
pubmed: 33612411
Catheter Cardiovasc Interv. 2022 May;99(6):1945-1952
pubmed: 35067004