Use of a Large-Bore Percutaneous Vascular Closure Device after va-ECMO Therapy

Objectives: Emergent veno-arterial extracorporeal support therapy (va-ECMO) is usually established by percutaneous cannulation of the common femoral artery (CFA). After successful weaning of the patient, the cannula is typically removed under manual compression of the puncture site or in an open surgically procedure. Both approaches are associated with specific complications like occurrence of secondary hemorrhage, pseudoaneurysms, lower limb ischemia, wound infections and seroma. For closure of large-bore percutaneous arteriotomies caused by the sheathes used for interventional procedures, specific percutaneous closure devices have been developed. These closure devices work via retrograde application of suture lines, and need to be applicated prior to the sheath insertion. Therefore, the use of these devices is regularly not performed in ECMO therapy. In this study, we want do describe the use of a newly-approved closure device that can be implanted after removal of the ECMO cannula in a cohort of eight patients.

Methods: We implanted the MANTA vascular closure device in eight patients that were successfully weaned from va-ECMO. Mean support time was 9.3 days (3–27 days). Baseline characteristics included an average age of 61.7 years (33–78) and average BMI of 27.4 (24–30.5).

The implantation depth of the MANTA system was calculated in 3D multiple plane reconstructions of existing CT scans. Four of the patients had a distal 7 Fr limb perfusion line in place that was sealed by a second small closure device (Angio-Seal). Distal leg perfusion was monitored using sonography and near-infrared spectroscopy (INVOS) before and after decannulation.

Results: Delivery of the closure device was feasible in all patients. In six patients, immediate hemostasis could be achieved without any further manipulation. In two patients minor bleeding of the access site could be controlled with manual compression within 15 minutes. None of the patients required surgical revision or transfusion of red blood concentrates within 48h after decannulation. There was no occurrence of clinical symptoms or technically measurable limb ischemia in INVOS and sonography.

Conclusions: The described technique of interventional vascular closure after successful va-ECMO therapy seems to have the potential to reduce complication rates of va-ECMO therapy. Nevertheless, further studies in larger cohorts are mandatory to examine the safety profile and to demonstrate clinical benefits of the technique.