The Use of Percutaneous Distal Aortic Perfusion and ECMO in the Treatment of Descending Thoracoabdominal Aortic Aneurysms

Objective: To describe the use of extracorporeal membrane oxygenation (ECMO) via percutaneously placed cannulae for descending thoracoabdominal aortic aneurysm (DTAA) repair.
Methods: From 2003 to 2005, 10 patients (2M: 8F) underwent DTAA repair (Crawford Type I= 2, Type III= 5, Type IV= 3). Preoperative ABI's were 1 or greater in all but one; spinal drains were placed in all patients. Following low-dose heparinization (ACT > 250), a right IJ 21 Fr. venous and a left femoral 15 Fr. arterial ECMO cannulas were placed. DTAA repair was performed in the right lateral decubitus position after initiatiating ECMO. Distal aortic perfusion was maintained at 2-3 liters/minute. Passive cooling was allowed during DTAA repair followed by active warming of the patients to 37°C with ECMO upon completion. Heparin reversal and manual hemostatis of the left groin were employed as the DTAA incision was closed. The right IJ venous cannula was removed with the patient in the supine position.
Results: Percutaneous arterial and venous cannulae were safely placed in all patients prior to the initiation of ECMO. No postoperative episodes of bleeding or pseudoaneurysms in the groin requiring exploration occured. No 30 day deaths occured, however 2 patients developed paraplegia/paraparesis (1 Type III, 1 Type IV). No patient developed new onset of claudication or rest pain. At a mean follow-up of 280 days, 9 out of the 10 patients are alive.
Conclusion: This novel experience using ECMO suggests that percutaneous distal aortic perfusion during DTAA appears safe with few lower extremity complications.