• R Giebler, R Scherer, J Erhard, R Lange, D Paar, and L Stöcker.
• Institut für Anästhesiologie, Universitätsklinikum Essen.
• Anaesthesist. 1996 Jan 1; 45 (1): 59-65.

UnlabelledPortofemoro-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.MethodsThe left femoral and subclavian veins were cannulated preoperatively 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.ResultsPercutaneous 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.ConclusionsThe 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.

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