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Interventional treatment of bleeding complications due to percutaneous cannulation for peripheral extracorporeal

L Zheng¹, P H Kim², J H Shin²

¹Department of Radiology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou City, China.

Diagnostic and Interventional Imaging

|January 30, 2019

Insights

Interventional techniques safely and effectively treat bleeding from peripheral extracorporeal membrane oxygenation (PECMO) cannulation. All patients had successful procedures with no complications or rebleeding during follow-up.

Area of Science:

Cardiovascular Interventions
Vascular Surgery
Critical Care Medicine

Background:

Bleeding complications can arise from percutaneous cannulation for peripheral extracorporeal membrane oxygenation (PECMO).
Prompt and effective management is crucial for patient outcomes.

Purpose of the Study:

To evaluate the safety and effectiveness of interventional techniques for managing bleeding complications secondary to PECMO cannulation.

Main Methods:

Retrospective review of eight patients who underwent percutaneous interventional treatment for PECMO-related bleeding.
Procedures included ultrasound-guided thrombin injection, embolization, and stent graft insertion.

Main Results:

Technical success was achieved in all eight patients.
No procedure-related complications or rebleeding occurred during follow-up.
Various interventional techniques were successfully employed based on the type of bleeding complication.

Conclusions:

Interventional treatment is a safe, feasible, and effective option for bleeding complications after PECMO cannulation.
These techniques offer a valuable therapeutic modality for managing these specific vascular emergencies.

Read full analysis

Abstract

Purpose:

This study aimed to evaluate the safety and effectiveness of interventional techniques as a treatment for bleeding complications secondary to percutaneous cannulation for peripheral extracorporeal membrane oxygenation (PECMO).

Materials And Methods:

Out of 1264 patients who underwent PECMO at our hospital between January 2009 and September 2018, we reviewed the clinical characteristics and outcomes of eight patients (4 men, 4 women; mean age, 54.9 years [range, 31-77 years]) who underwent percutaneous interventional treatment for bleeding complications secondary to percutaneous cannulation for PECMO.

Results:

Both hemodynamic instability and coagulopathy were present in 7 patients who had direct injury during PECMO insertion and absent in one patient with pseudoaneurysm at the PECMO removal site. Percutaneous ultrasound-guided thrombin injection was performed in three patients with pseudoaneurysm of the common or superficial femoral artery, and adjunctive embolization was combined with microcoils or n-butyl 2-cyanoacrylate in two of them. Stent graft was inserted in four patients with contrast extravasation (n=3) from external iliac artery (n=1) or common femoral or iliac veins (n=2) ruptures or the fistula between the superficial femoral artery and vein (n=1). N-butyl 2-cyanoacrylate and coil embolization was performed for pseudoaneurysm from the internal pudendal artery branch in the remaining one patient. Technical success was achieved in all eight patients. There were no procedure-related complications. There was no rebleeding during the follow-up.

Conclusion:

Interventional treatment is a safe, technically feasible and therapeutically effective modality for treating bleeding complications secondary to a percutaneous cannulation for PECMO.

Keywords:

Bleeding complications Iatrogenic injury Interventional radiology Peripheral extracorporeal membrane oxygenation

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