Percutaneous decannulation of extracorporeal membrane oxygenation using a plug-based closure device

Abstract

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.

Keywords: MANTA; vascular closure device; venoarterial extracorporeal membrane oxygenation.

Figure 1

Schematic representation of arterial access closure with the MANTA vascular closure device (Teleflex/Essential Medical). (A) The MANTA closure device delivery handle. (B) A stiff guidewire is introduced in the femoral artery and the extracorporeal membrane oxygenation arterial cannula is exchanged for the MANTA sheath. (C) The introducer is withdrawn. (D) The closure unit is inserted. (E) The closure unit is withdrawn to the appropriate deployment level and the intravascular absorbable polymer toggle is released. (F) The absorbable collagen pad is secured onto the anterior arterial wall by a stainless‐steel lock, sandwiching the arterial wall between the intravascular toggle and the extravascular collagen pad. After hemostasis, the suture is cut at skin level. Images courtesy of Teleflex/Essential Medical Inc. [Color figure can be viewed at wileyonlinelibrary.com]