Modified T-graft for extracorporeal membrane oxygenation: In a patient with small-caliber femoral arteries

Daniel Calderon, Aly El-Banayosy, Michael M. Koerner, Amy B. Reed, Faisal Aziz

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Extracorporeal membrane oxygenation (ECMO) is generally used as a last resort to provide cardiopulmonary support in patients whose advanced cardiac or respiratory failure does not respond to less invasive treatments. Lower-limb ischemia secondary to the large diameter of the arterial cannula is one of ECMO’s major limitations: in patients who have smallcaliber arteries, the cannulas can reduce native blood flow. The creation of a T-graft—a well-described technique to avoid limb ischemia—enables flow into the ECMO cannula without jeopardizing blood flow to the limb. However, leaving the graft exposed through an open groin wound can result in dislodgment, and it increases the risk of infection. We describe our modification of a conventional T-graft in an 18-year-old woman who had systolic heart failure, acute respiratory distress syndrome, and small-caliber femoral vessels. We tunneled a polytetrafluoroethylene graft inside a Dacron graft, then ran the combined graft through a subcutaneous tunnel similar to that created for a peripheral bypass. Thus, the graft was protected from environmental exposure and the risk of infection. Our technique seems safer and more secure than the original T-graft technique, and we recommend its consideration during ECMO cannulation.

Original languageEnglish (US)
Pages (from-to)537-539
Number of pages3
JournalTexas Heart Institute Journal
Volume42
Issue number6
DOIs
StatePublished - Dec 1 2015

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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