一名71岁无相关既往病史的女性因广泛性心肌梗死而出现心肺骤停,前往急诊科就诊。静脉动脉体外生命支持(ECLS)通过右股总动脉(CFA),和ImpellaCP®(16-F引入鞘,AbiomedInc.,丹弗斯,MA,美国)从左侧CFA插入。尽管这些机械装置提供了强大的心脏和器官支持,闭塞性大口径鞘管可引起缺血性肢体并发症。来自对侧鞘管的顺行流通过ECLS回路循环,显示出顺行左SFA的改善。直接经皮冠状动脉介入治疗后心功能改善,但是当ECLS终止时,顺行左肢体流量下降。因此,我们通过透析回路绕过对侧血流,防止了肢体缺血.
■虽然是Impella®(AbiomedInc.,丹弗斯,MA,美国)对辅助左心室心功能有用,它的大口径护套有时会干扰顺行流,导致肢体缺血并发症。在此描述了一种新颖而简单的技术,该技术涉及通过股浅动脉的外部旁路,以向同侧肢体提供顺行灌注。
A 71-year-old woman with no relevant previous medical history presented to the emergency department with cardiopulmonary arrest due to extensive myocardial infarction. Veno-arterial extracorporeal life support (ECLS) was passed through the right common femoral artery (CFA), and an Impella CP® (16-F introduction sheath, Abiomed Inc., Danvers, MA, USA) was inserted from the left CFA. Although these mechanical devices provide powerful cardiac and organ support, an occlusive large-bore sheath may induce ischemic limb complications. Antegrade flow from the contralateral sheath was circulated through the ECLS circuit, showing the improvement of antegrade left SFA. Cardiac function improved after primary percutaneous coronary intervention, but when the ECLS was terminated, antegrade left limb flow declined. Hence, we bypassed the contralateral flow via the dialysis circuit and prevented limb ischemia.
UNASSIGNED: Although an Impella® (Abiomed Inc., Danvers, MA, USA) is useful for assisting left ventricular cardiac function, its large-bore sheath sometimes disturbs the antegrade flow, resulting in ischemic limb complications. A novel yet simple technique that involves an external bypass through the superficial femoral artery to provide antegrade perfusion to the ipsilateral limb is hereby described.