초록접수 현황
| 16F-261 | 포스터 발표 |
Various Techniques for Distal Limb Perfusion during Extracorporeal Membrane Oxygenation - Usefulness of Bedside Ultrasound and Angiography
Min Suk Choi, Jin Ho Choi
Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
Background : One of the most terrible complications during venoarterial extracorporeal membrane oxygenation (ECMO) is distal limb ischemia. So additional perfusion to the distal limb has been done. We are going to report various techniques for distal limb perfusion.
Methods : Thirty patients to whom distal limb perfusion was done in our institute between August 2012 and July 2016 were analyzed retrospectively. The indication was no pulsatile flow in the popliteal or posterior tibial artery, which was checked by ultrasonography right after ECMO cannulation. Ultrasound guided sheath insertion into the superficial femoral artery was done in 23 patients and sheath was inserted directly through the surgically exposed femoral artery in 5 patients. Distal perfusion by 7Fr guiding catheter which was inserted from the contralateral femoral artery was done in 2 patients.
Results : Percutaneous sheath insertion guided by ultrasound and then beside angiography using a portable X ray which shows the image on the spot have been done the most. It was very simple because it is a bedside procedure and the accuracy was high (22/25, 88%). Two among 5 direct insertions were done through a separate incision from ECMO cannulas. Contralateral selection with guiding sheath was useful when C arm fluoroscopy was available. Final angiography was taken in 25 (83.3%) cases to confirm if the sheath was inserted correctly in the superficial femoral artery or there is a stenotic lesion in the distal arteries. A case of deep femoral arterial insertion has been found by angiography. All cases except 1 were done before limb ischemia advances. There was no complication except a case of wound dehiscence.
Conclusion : A different method can be chosen for different situations and we want to suggest to use bedside ultrasound and angiography particularly because it is simple and accurate.
Methods : Thirty patients to whom distal limb perfusion was done in our institute between August 2012 and July 2016 were analyzed retrospectively. The indication was no pulsatile flow in the popliteal or posterior tibial artery, which was checked by ultrasonography right after ECMO cannulation. Ultrasound guided sheath insertion into the superficial femoral artery was done in 23 patients and sheath was inserted directly through the surgically exposed femoral artery in 5 patients. Distal perfusion by 7Fr guiding catheter which was inserted from the contralateral femoral artery was done in 2 patients.
Results : Percutaneous sheath insertion guided by ultrasound and then beside angiography using a portable X ray which shows the image on the spot have been done the most. It was very simple because it is a bedside procedure and the accuracy was high (22/25, 88%). Two among 5 direct insertions were done through a separate incision from ECMO cannulas. Contralateral selection with guiding sheath was useful when C arm fluoroscopy was available. Final angiography was taken in 25 (83.3%) cases to confirm if the sheath was inserted correctly in the superficial femoral artery or there is a stenotic lesion in the distal arteries. A case of deep femoral arterial insertion has been found by angiography. All cases except 1 were done before limb ischemia advances. There was no complication except a case of wound dehiscence.
Conclusion : A different method can be chosen for different situations and we want to suggest to use bedside ultrasound and angiography particularly because it is simple and accurate.
책임저자: Jin Ho Choi
Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
발표자: Min Suk Choi, E-mail : doctorchoi@ymail.com