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Published on: May 31, 2022
Arterial Changes After Vascular Reconstruction Following Decannulation From Extracorporeal Life Support:
Eustina G Kwon1, D Michael McMullan2, Elina Quiroga3
1Department of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA.
Objectives:
Decannulation after pediatric extracorporeal life support (ECLS) may be accompanied by arterial reconstruction. There is a paucity of data on arterial morphology following reconstruction. We sought to characterize morphology of reconstructed arteries to better understand long-term risk of arterial narrowing and blood flow alteration.
Design:
Retrospective, single-institution review, 2002-2022.
Setting:
Free-standing, 420-bed quaternary care children's hospital in the U.S. Pacific Northwest.
Patients:
We identified children of any age who were decannulated from ECLS with arterial reconstruction, using a 20-year registry. We excluded patients who did not survive.
Interventions:
None.
Measurements And Main Results:
We collected patient demographics data, indications for ECLS, reconstruction strategies, surgeon specialty, and any available post-decannulation imaging results. Associations between variables and morphologic changes were assessed on univariate analysis and then combined into a forward stepwise multivariable regression model (using p = 0.20 as a threshold). Among surviving patients, 144 underwent carotid artery reconstruction and 25 femoral, with 59 of 144 (41.0%) and 23 of 25, respectively, undergoing post-reconstruction imaging. Follow-up imaging was performed at a median of 21 and 9 days, respectively. On follow-up, 25 of 59 patients (42%) undergoing carotid reconstruction and eight of 23 patients undergoing femoral reconstruction had occlusion or other morphologic changes on imaging. Neonatal age at reconstruction was a significant risk factor for these changes.
Conclusions:
A considerable proportion of patients undergoing arterial reconstruction after decannulation from ECLS develop vessel occlusion or other morphologic changes in short-term follow-up. Longer-term imaging is critical to aid risk stratification as ECLS survivors enter adulthood with attendant risks for atherosclerotic vascular disease.
