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Evaluation of the reconstructed carotid artery following extracorporeal membrane oxygenation
B J Taylor1, J J Seibert, C M Glasier
1Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock 72205.
Insights
Neonatal carotid artery repair after extracorporeal membrane oxygenation (ECMO) is feasible. Follow-up Doppler imaging showed initial vessel narrowing is reversible, with no increased risk of brain injury.
Area of Science:
- Pediatric Surgery
- Neonatal Intensive Care
- Vascular Surgery
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support measure for neonates with respiratory failure.
- Carotid artery injury can occur during or after ECMMO, potentially leading to complications.
- Surgical repair of the carotid artery is a consideration in managing these patients.
Purpose of the Study:
- To evaluate the technical feasibility and outcomes of common carotid artery repair in neonates following ECMMO.
- To assess the degree of stenosis and blood flow dynamics at the repair site using Doppler imaging.
- To determine the long-term patency and potential for reversibility of vascular narrowing, and to evaluate the risk of embolic events.
Main Methods:
- Retrospective review of 28 neonates undergoing ECMMO over 12 months.
- Duplex color-flow Doppler imaging performed between 14-109 days and again at 1 year of age in 9 infants post-carotid artery repair.
- Measurement of velocity ratio (A/B) to quantify stenosis at the anastomosis site.
Main Results:
- Successful carotid artery repair was performed in 11 neonates post-ECMO.
- Doppler imaging in 9 infants revealed initial obstruction in 8/9, with 4/9 having A/B ratios > 2.0 (indicating >50% stenosis).
- Follow-up scans showed marked improvement in A/B ratios and vessel patency, indicating reversibility of stenosis. No infant showed evidence of embolic brain injury on MRI.
Conclusions:
- Common carotid artery repair is technically feasible in neonates after ECMMO.
- Initial post-repair vascular narrowing is often reversible, with significant improvement in blood flow dynamics over time.
- Carotid artery repair following ECMMO can be performed without an increased risk of neonatal brain injury.
Abstract:
Over a 12-month period, 28 neonatal patients in respiratory failure were supported with extracorporeal membrane oxygenation (ECMO), and 11 of these underwent successful repair of the right carotid artery post-ECMO. Nine of 11 were studied with duplex color-flow Doppler imaging between 14 and 109 days of age and again at 1 year of age. A velocity ratio (A/B) of the peak systolic velocity above the level of the anastomosis to the peak systolic velocity below the anastomosis was measured to assess the degree of stenosis, if any, at the repair site. Antegrade flow through the carotid was detected post-ECMO in 8 of 9 infants, and antegrade and retrograde flow was documented in 1 infant. A/B ratios ranged from 1.00 to 8.60 (A/B ratio of 1 is normal; 2.0 indicates at least a 50% obstruction to flow). Four of 9 patients had ratios greater than 2.0, and 8 of 9 exhibited some evidence of obstruction. Follow-up scans were performed on 8 of 9 infants between 12 and 18 months of age. All infants examined showed marked improvement in A/B ratio and patency of the vessel, documenting that initial narrowing of the vessel is reversible. No infant had evidence of embolic phenomena to the right side of the brain by magnetic resonance imaging. Repair of the common carotid artery post-ECMO is technically feasible without increasing the risk of brain injury.