Dual-layer everted saphenous vein patch for pediatric femoral artery repair following ECMO decannulation
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In brief
In brief
This operative technique describes a dual-layer everted saphenous vein patch for repairing large femoral arteriotomies after pediatric VA-ECMO decannulation. The method uses ipsilateral saphenous vein harvested through the same incision, everted to maximize endothelial contact and dual-layered for structural support, providing an accessible approach for pediatric surgeons without advanced vascular training to minimize complications and preserve lower extremity perfusion.
Written by the GCMD Library team from the article.
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 of Evidence
Level IV; operative technique description with small case series.