Percutaneous vascular closure technique using parallel closure in extracorporeal membrane oxygenation decannulation:...

Area of Science:

• Cardiovascular Surgery
• Critical Care Medicine
• Interventional Cardiology

Background:

• Closing large femoral arterial access sites after veno-arterial extracorporeal membrane oxygenation (VA-ECMO) decannulation is challenging.
• Suture-mediated percutaneous closure is an alternative to surgical repair, but optimal configurations are unclear.
• Conventional cross-suture techniques may have limitations for VA-ECMO decannulation.

Purpose of the Study:

• To describe a novel parallel percutaneous closure technique for large-bore femoral arterial access.
• To evaluate the initial feasibility and safety of this parallel closure technique.
• To assess potential improvements in outcomes compared to conventional methods.

Main Methods:

• A prospective case series of 30 adult patients undergoing bedside VA-ECMO decannulation.
• Deployment of two Perclose ProGlide devices in a parallel configuration for femoral arterial closure.
• Assessment of technical success and vascular complications via clinical evaluation and duplex Doppler ultrasound at 24 hours.

Main Results:

• 100% technical success was achieved in all 30 patients, with no need for surgical conversion or additional interventions.
• Normal arterial flow was confirmed by duplex ultrasound in 76.7% of patients.
• Early vascular complications included thrombosis (16.7%), dissection (3.3%), and hematoma (3.3%), with no limb ischemia.

Conclusions:

• The parallel percutaneous closure technique appears feasible and safe for large-bore femoral decannulation post-VA-ECMO.
• Bedside application under local anesthesia and a low rate of early complications highlight its clinical utility.
• Further research is needed to compare different closure configurations and assess long-term outcomes.