Dual-layer everted saphenous vein patch for pediatric femoral artery repair following ECMO decannulation

• Published in: Journal of pediatric surgery Vol. 55; no. 7; pp. 1409 - 1413
• Main Authors: Sorber, Rebecca, Pedroso, Felipe E., Murphy, Jennifer M., Stewart, Dylan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2020
• Subjects: Catheterization, Peripheral - methods; Child; Extracorporeal Membrane Oxygenation - methods; Femoral Artery - surgery; Humans; Iatrogenic vascular injury; Patch angioplasty; Pediatric vascular surgery; Saphenous Vein - transplantation; Vascular Surgical Procedures - methods; Vascular trauma; Vascular trauma; Iatrogenic vascular injury; Patch angioplasty; Pediatric vascular surgery
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2020.02.055

Decannulation from pediatric veno-arterial extracorporeal membrane oxygenation (VA-ECMO) involves the removal of large arterial perfusion cannulas from relatively small lower extremity arteries. While these challenging repairs are frequently performed by general pediatric surgeons, there is little standardization with regard to vascular techniques within the pediatric surgery training paradigm, resulting in variability in the repair of these arteriotomies and potential future consequences for lower extremity perfusion and growth. Herein we present a technique for repair of large common femoral arteriotomies following removal of ECMO perfusion cannulas utilizing a dual-layer patch of ipsilateral saphenous vein harvested via the arterial cutdown incision. This vein segment is everted to maximize endothelial surface area of the patch and dual layered to provide additional support against aneurysmal degeneration. The described technique is an effective repair of arteriotomy following VA-ECMO decannulation, which minimizes vascular complications and is an accessible technique to those without advanced vascular surgical training. Level IV; operative technique description with small case series.