Percutaneous Vascular Cannulation for Extracorporeal Life Support (ECLS): A Modified Technique

Abstract

Vascular access and cannulation are crucial issues to maximize the efficiency of extracorporeal circulation techniques and to preserve patients' safety. Techniques of cannulation have changed over the years, from surgical cutdown to percutaneous approaches, which are now considered standard practice. We describe an original modified percutaneous cannulation technique developed in our Department and we report our clinical experience and complications observed. A Seldinger technique utilizing 3 guidewires with passage of a dilator over each guidewire was used. Two concentric pursestring sutures, prepared before cannulation, minimize procedure-associated bleeding. Cannulation is performed under direct fluoroscopic control. From 1997 to 2009, 38 patients (31 VV-ECLS, 7 VA-ECLS) have been cannulated using our technique, resulting in a total of 69 venous cannulations. Average external caliber of venous cannulae was 23 Fr (15-29 Fr). Mean duration of the entire cannulation procedure was 40 minutes (20-60 min). Adverse events occurred in 3 patients. The technique described is safe and feasible and the incidence of procedure-related complications is very low, but it may require longer time to be performed.