Femoral artery cannulation through a side graft in extracorporeal membrane oxygenation

Femoral vessels are the most used peripheral vessels for veno-arterial Extracorporeal Membrane Oxygenation (ECMO) support in adults and older children. They are easily harvested and are associated with a low incidence of neurological events. In order to reduce bleeding and infection, the percutaneous technique is usually preferred to the open technique. Nevertheless this is associated to possible lower leg extremity ischemia (1) which is most commonly dealt with by using distal perfusion catheters (2). However, despite the use of such catheters, ischemic complications are still described (3). In the last 6 months we adopted a novel technique of femoral artery (FA) cannulation. The femoral vessels are harvested at the groin. The FA is clamped and incised longitudinally and a 8-mm Dacron graft (Vascutek, Scotland, UK) is anastomosed with a 6.0 prolene. At the end of the anastomotic procedure, an heparinized saline solution (25 mg of heparin in 500 cc. saline) is injected into the graft. The graft is subsequently clamped and the femoral artery is declamped in order to allow coagulation of