ISSN:
1432-055X
Keywords:
Schlüsselwörter Orthotope Lebertransplantation
;
Perkutane Punktionstechnik
;
Portofemoro-subklavikulärer venovenöser Bypass
;
Key words Orthotopic liver transplantation
;
Veno-venous bypass
;
Central venous catheterisation
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Description / Table of Contents:
Abstract Portofemoro-axillary bypass systems are commonly used to treat adverse haemodynamic effects during the anhepatic phase of orthotopic liver transplantation (OLT). However, low shunt flows may reduce the efficacy of these bypass systems. In order to improve veno-venous bypass management, a percutaneous cannulation technique (PCT) was used to insert large-bore catheters (21 F) into the left femoral and subclavian veins. This study prospectively addresses the complications of the PCT in 195 adult patients undergoing 203 OLTs. Methods. The left femoral and subclavian veins were cannulated pre-operatively with 21 F single-lumen catheters (DLP, Grand Rapids, MN, USA) using a Seldinger technique. Intra-operatively, the centrifugal pump (Biopump, Biomedicus, Minnesota, USA) and the portal part of the bypass were connected with the femoral and subclavian catheters. Coagulation profiles, shunt flows, haemodynamic parameters, and complications during OLT associated with the bypass system were recorded. Results. Percutaneous cannulation of the left subclavian and femoral veins was successful in 198 (97.6%) patients. Mean portofemoro-subclavian shuntflow was 4.3 (SD 1.3 l min−1). Although cardiac index (shunt 3.91 [SD 1.1] vs pre-shunt 4.42 [SD 1.0] l min−1 m−2, P〈0.05) and oxygen delivery (shunt 496 [SD 111] vs. pre-shunt 562 [SD 153] ml ml−1·m−2, P〈0.05) were not maintained at pre-shunt levels, renal perfusion pressure stayed above 50 mm Hg during the anhepatic phase. Two intra-operative air embolism (0.98%) and one myocardial infarction(0.49%) at the beginning of the anhepatic phase were observed. There were no bleeding complications. Conclusions. The portofemoro-subclavian bypass can be performed by percutaneous cannulation without additional complications in patients undergoing OLT. Although haemorrhagic complications following central venous catheterisation are reported to occur in patients with haemostatic defects, none of them was observed in this study. Two events of air embolism and one cardiac arrest could not be related to the PCT. In conclusion, femoro-subclavian percutaneous cannulation is a simple, rapid, and safe alternative to commonly used veno-venous bypass systems.
Notes:
Zusammenfassung Venovenöse Bypass-Systeme werden häufig während der anhepatischen Phase der orthotopen Lebertransplantation (OLT) zum Erhalt des venösen Rückstroms aus dem portalen und kavalen Stromgebiet eingesetzt. Zur Vereinfachung und Effektivitätssteigerung dieser Systeme wurde eine perkutane Kanülierungstechnik benutzt, mit der großlumige Katheter (21 F) in Seldingertechnik in die Vv. femoralis und subclavia links eingeführt werden. Gerinnungsprofile, Shuntflows, hämodynamische Parameter und die mit dem Kathetersystem verbundenen perioperativen Komplikationen wurden bei 203 OLTs an 195 Patienten prospektiv erfaßt. Die perkutane Kanülierung der linken V. femoralis bzw. V. subclavia gelang jeweils in 198 (97,6%) Fällen. Der mittlere femoro-subklavikuläre Shuntflow betrug 1,45 l min −1 (±0,37 SD), der mittlere portofemoro-subklavikuläre Flow betrug 4,28 l min −1 (±1,03 SD). Als nicht auf die perkutane Punktionstechnik zurückzuführende Komplikationen wurden zwei Luftembolien und ein Myokardinfarkt in der anhepatischen Phase beobachtet. Die Häufigkeit punktionsspezifischer Komplikationen lag unter den für die Anlage zentraler Venenkatheter in der Literatur angegebenen Werten. Die beschriebene Technik ist eine zeitsparende, einfache, effektive und sichere Methode, mit der die negativen hämodynamischen Auswirkungen während der anhepatischen Phase der OLT reduziert werden können.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/s001010050241
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