Lower-extremity complications with femoral extracorporeal life support

Abstract

Objective: Patients undergoing emergency peripheral arteriovenous extracorporeal life support were evaluated for lower-extremity complications on the basis of the ipsilateral limb perfusion strategy.

Methods: In a retrospective review of patients receiving extracorporeal life support (2008-2013), 105 of 250 underwent femoral extracorporeal life support. For ipsilateral lower-extremity perfusion, patients underwent no superficial femoral artery cannulation (n = 35), percutaneous superficial femoral artery cannulation (n = 23), or open superficial femoral artery cannulation (n = 47).

Results: Patients' mean age was 50 ± 16 years, and 63% (n = 67) were male. A total of 92 patients (88%) had primary cardiac emergency, and 13 patients (12%) had cardiopulmonary emergency. The 30-day in-hospital mortality was 65% (n = 68), with an overall lower-extremity complication rate of 13% (n = 14). Lower-extremity complications were highest in the percutaneous superficial femoral artery (n = 6, 26%) and no superficial femoral artery (n = 7, 20%) groups (n = 1 [2%] in open superficial femoral artery group). In 2 group comparisons, the open superficial femoral artery group had significantly lower lower-extremity complications than the no superficial femoral artery (P = .02) and percutaneous superficial femoral artery (P = .004) groups. There was no difference between the no superficial femoral artery and percutaneous superficial femoral artery groups (P = .7). In the no superficial femoral artery group, emergency thromboembolectomy (n = 2), fasciotomy (n = 3), and emergency superficial femoral artery cannula placement (n = 2) were required. In the percutaneous superficial femoral artery group, thromboembolectomy with superficial femoral artery repair (n = 2), fasciotomy (n = 1), below-knee amputation (n = 1), open superficial femoral artery cannula revision (n = 1), and loss of distal signals from multiorgan failure (n = 1) were noted. In the open superficial femoral artery group, 1 patient had loss of signals from multiorgan failure.

Conclusions: No superficial femoral artery perfusion strategy is associated with a high lower-extremity complication rate. If percutaneous cannulation is performed, then angiographic confirmation of superficial femoral artery run-off is highly recommended. The open superficial femoral artery approach remains a safe alternative to the other strategies.