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Femoral artery anatomy is a risk factor for limb ischemia in minimally invasive cardiac surgery

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Abstract

Objective

In minimally invasive cardiac surgery (MICS), femoral artery cannulation during cardiopulmonary bypass (CPB) can cause limb ischemia. This study evaluated the association between femoral artery anatomy and the risk of limb ischemia in MICS.

Methods

Eighty-one patients who underwent MICS with CPB using single femoral artery cannulation between 2010 and 2018 were included. The patients were stratified by their femoral artery diameter and anatomy of ectopic side branch, i.e., medial or lateral femoral circumflex arteries: Type A, deep femoral artery (DFA) ≥ superficial femoral artery (SFA); type B, DFA < SFA with an ectopic side branch of the common femoral artery (CFA); type C, DFA < SFA with an ectopic side branch at the CFA bifurcation; and type D, DFA < SFA without an ectopic side branch. The ratio of the postoperative creatine kinase concentration and the cross-sectional area of the femoral muscles (CK/MA) was used as a surrogate marker of limb ischemia. Predictors of high CK/MA were evaluated.

Results

No critical limb ischemia was observed in this study. The median postoperative creatine kinase and CK/MA were 1954 (1305–2872) IU/l and 15.2 (9.2–19.8) IU/l/cm2. Multivariable logistic regression found that anatomical type D (odds ratio 4.19, 95% confidence interval: (1.26–14.0); p = 0.020) and prolonged CPB time (OR 1.01, 95% CI (1.00–1.02); p = 0.045) were independent risk factors of high CK/MA.

Conclusion

Anatomical type D and prolonged CPB time were associated with risk of limb ischemia in MICS.

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Acknowledgements

We are grateful to Dr. Hiroki Sato for assistance with the statistical analyses.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Oita University, 1-1 idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan

    Takayuki Kawashima, Keitaro Okamoto, Tomoyuki Wada, Takashi Shuto, Tadashi Umeno & Shinji Miyamoto

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  1. Takayuki Kawashima
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  2. Keitaro Okamoto
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  3. Tomoyuki Wada
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  4. Takashi Shuto
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  5. Tadashi Umeno
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  6. Shinji Miyamoto
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Correspondence to Takayuki Kawashima.

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Kawashima, T., Okamoto, K., Wada, T. et al. Femoral artery anatomy is a risk factor for limb ischemia in minimally invasive cardiac surgery. Gen Thorac Cardiovasc Surg 69, 246–253 (2021). https://doi.org/10.1007/s11748-020-01442-y

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  • DOI: https://doi.org/10.1007/s11748-020-01442-y

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