Reconstruction of the Carotid Artery Following Extracorporeal Membrane Oxygenation (ECMO)

Abstract

Although ligation of the carotid artery following extracorporeal membrane oxygenation (ECMO) procedures has not been associated with any apparent acute neurologic changes, its long-term sequelae on cerebral function are still unknown. The authors have adopted a policy of repairing all carotid arteries following ECMO. Between April 1990 and June 1993, 34 consecutive patients underwent carotid artery reconstruction. Indications for ECMO were respiratory distress syndrome in 18, meconium aspiration in 8, pneumonia in 6, myocardial failure in 1, and sickle cell anemia in 1. All patients were neonates (ages seventy-two ± sixty-three hours), except 5 (2, three months; 1, two years; and 2, four years old).

Duration of ECMO was (mean ± SD, 156 ± 68 hours). Arterial cannulation was performed after extended mobilization of the carotid artery by using a Biomedicus (8- 10F) cannula. Following decannulation the traumatized segment was resected and the artery repaired by means of multiple interrupted nonabsorbable 7-0 sutures. No heparin was given. There were no complications related to repair.

Follow-up is available on all patients (7.6 ±4.1 months). Detailed neurologic evalu ation and ultrasound and Doppler studies of the carotid artery were performed on all patients at discharge, at two months, at six months, and at one year following ECMO. All carotid arteries were patent with good flow, except one. Transient communicating hydro cephalus developed in 1 patient but responded readily to medical treatment. The rest have normal-for-age neurologic evaluation. The authors' experience suggests that carotid reconstruction following ECMO is feasible, safe, and probably advantageous in the long term. Further follow-up is necessary before this technique can be applied to all infants undergoing ECMO procedure.

Get full access to this article

View all access options for this article.

References

Bartlett RH , Gazzaniga AB , Huxtable RF , et al: Extracorporeal circulation (ECMO) in neonatal respiratory failure . J Thorac Cardiovasc Surg 74:826-833, 1977.

Lott IT , McPherson D. , Towne B. , et al: Long-term neurophysiologic outcome after neonatal extracorporeal membrane oxygenation. J Pediatr 116:343-349, 1990.

Lott IT , Towne BH , McPherson DM , et al: Permanent ligation of the right common carotid artery at birth: 18 cases. Pediatr Res 19 (suppl):392A, 1985 .

Schumacher RE , Barks Jde , Johnston MV , et al: Right-sided brain lesions in infants following extracorporeal membrane oxygenation. Pediatrics 82:155-161, 1988.

Voorhies TM , Tardo CL , Andrea LS , et al: Evaluation of the cerebral membrane oxygenation. Ann Neurol 18:380, 1985.

Perlman JM , Altman DI , Powers WJ , et al: Cerebral injury and regional cerebral blood flow in newborn infants undergoing extracorporeal membrane oxygenation. Ann Neurol 22:421, 1987.

Symon L. , Wang AD , Costa E. , et al: Perioperative use of somatosensory evoked responses in aneurysm surgery. J Neurosurg 60:269-275, 1984.

Hargadine JR , Branston NM , Symon L. : Central conduction time in primate brain ischemia—a study in baboons. Stroke 11:637-642, 1980.

Branston NM , Symon L. , Crockard HA , et al: Relationship between the cortical evoked potential and local cortical blood flow following acute middle cerebral artery occlusions in the baboon. Exp Neurol 45:195-208, 1974.

10.

Oldershaw JB , Voris HC : Internal carotid artery ligation. Neurology 16:937-938, 1966.

11.

Moulton SL , Lynch FP , Cornish JD , et al: Carotid artery reconstruction following neonatal extracorporeal membrane oxygenation. J Pediatr Surg 26:794-799, 1991.

12.

Adolph V. , Bonis S. , Falterman K. , et al: Carotid artery repair after pediatric extracorporeal membrane oxygenation. J Pediatr Surg 25:867-870, 1990.

13.

Liebman PR , Barnes RW : Complications of vascular surgery and trauma. In: Complications in Surgery and Trauma, ed. by Greenfield LJ. Philadelphia: Lippincott, 1984, pp 353-369.

14.

Castaneda AR , Norwood WI , Jonas RA , et al: Transposition of the great arteries and intact ventricular septum: Anatomical repair in the neonate. Ann Thorac Surg 38:438-443, 1984.