Surgical Decannulation Using the Purse-String Technique in Venoarterial Extracorporeal Membrane Oxygenation Patients

Area of Science:

• Cardiovascular Surgery
• Extracorporeal Life Support
• Vascular Access Management

Background:

• Femoral arterial decannulation after V-A ECMO can cause significant vascular complications.
• The purse-string technique is a less invasive alternative to conventional methods.
• Limited clinical data exist on the safety and feasibility of the purse-string technique.

Purpose of the Study:

• To evaluate the safety and efficacy of the purse-string technique for femoral arterial decannulation post V-A ECMO.
• To compare outcomes of purse-string decannulation with the conventional cross-clamp method.

Main Methods:

• Retrospective analysis of 325 adult patients undergoing femoral arterial decannulation after V-A ECMO (2012-2023).
• 87 patients received purse-string decannulation; propensity score matching was used for comparison.
• Outcomes were compared against the conventional cross-clamp repair method.

Main Results:

• Purse-string technique significantly reduced operative time (74.1 min vs. 132.9 min; p < 0.001).
• No increase in reintervention rates with the purse-string technique.
• Fewer symptomatic complications, vessel injuries, and late vascular complications observed in the purse-string group; no limb loss occurred.

Conclusions:

• The purse-string technique is an efficient, safe, and less invasive option for V-A ECMO decannulation.
• This method is advantageous for critically ill patients and bedside procedures.
• It minimizes operative time and vascular trauma, improving patient outcomes.