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Original Article
Cardiology Percutaneous vascular closure technique using parallel closure in extracorporeal membrane oxygenation decannulation: technical note and case series
Acute and Critical Care 2026;41(2):335-343.
DOI: https://doi.org/10.4266/acc.002675
Published online: April 17, 2026

1Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam

2Center for Critical Care Medicine, Bach Mai Hospital, Ha Noi, Vietnam

Corresponding author: Van Huy Nguyen Department of Emergency and Critical Care Medicine, Hanoi Medical University, No. 01, Ton That Tung St, Dong Da District, Hanoi 100000, Vietnam Tel: +84-98-189-9501, Email: nguyenhuy@hmu.edu.vn
• Received: May 18, 2025   • Revised: November 15, 2025   • Accepted: January 15, 2026

© 2026 The Korean Society of Critical Care Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Background
    Achieving safe and effective closure of large-bore femoral arterial access after venoarterial extracorporeal membrane oxygenation (VA-ECMO) decannulation remains challenging. Percutaneous closure with suture-mediated devices is an established alternative to surgical repair for VA-ECMO decannulation. However, the optimal suture configuration is not well defined, and conventional cross-suture placement may have limitations. This study describes a parallel percutaneous closure technique with the potential to improve outcomes and evaluates its initial feasibility and safety.
  • Methods
    This prospective case series included 30 adult patients who underwent bedside decannulation from percutaneous femoral VA-ECMO between March 2024 and March 2025. The closure technique involved deploying two Perclose ProGlide devices (Abbott Vascular) in a parallel configuration. The primary endpoints of technical success and vascular complications were assessed clinically and by duplex Doppler ultrasound 24 hours post-procedure.
  • Results
    Technical success was achieved in all 30 patients (100%) without surgical conversion or adjunctive vascular intervention. Duplex ultrasound confirmed normal arterial flow in 23 patients (76.7%). Vascular complications included arterial thrombosis (16.7%), dissection (3.3%), and hematoma (3.3%). No patient required reintervention or developed limb ischemia within 24 hours.
  • Conclusions
    This preliminary case series suggests that the parallel percutaneous closure technique is feasible and potentially safe for large-bore femoral decannulation following VA-ECMO. Its bedside application under local anesthesia and low rate of early complications support its utility in critical care. Further studies comparing closure configurations and evaluating long-term outcomes are warranted.
  • Key Words: arterial thrombosis; femoral artery; percutaneous vascular closure; peripheral catheterization; suture techniques; vascular closure devices; venoarterial extracorporeal membrane oxygenation
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in patients with severe cardiopulmonary failure [1-3]. Percutaneous femoral artery cannulation is often preferred for its rapid deployment and lower procedural invasiveness [4,5]. However, achieving safe and effective closure of large-bore arterial access sites remains a challenge, particularly when surgical exposure and general anesthesia need to be avoided.
While open surgical closure remains the standard in many centers, percutaneous closure using suture-mediated devices like the Perclose ProGlide devices (Abbott Vascular) has emerged as a less invasive alternative that reduces complications, particularly infections [6,7]. Both post-closure and pre-closure techniques have been described in the literature. The post-closure approach demonstrated in the seminal work by Hwang et al. [4] has become a common method for VA-ECMO decannulation. More recently, novel pre-closure strategies such as the “pre-anchoring and post-securing” technique described by Lee et al. [8] have also been reported, highlighting ongoing innovations in this field.
Despite the established use of Perclose ProGlide devices, the optimal suture configuration remains a subject of discussion. Conventional cross-suture placement may result in incomplete hemostasis or vessel distortion. Furthermore, the efficacy of suture-mediated closure is influenced by anatomical factors, with challenges reported in heavily calcified or small-caliber vessels [9].
The parallel suture placement technique—where two devices are deployed side by side—aims to address the limitations of the cross-suture method by enhancing hemostasis and preserving arterial geometry [10]. Although this technique has been described in other large-bore procedures such as transcatheter aortic valve replacement, systematic evaluation in the high-risk ECMO population, who often present with coagulopathy and prolonged cannulation duration, remains limited [10,11]. Therefore, the primary objectives of this study were to: (1) describe our parallel percutaneous closure technique for VA-ECMO decannulation performed at the bedside under local anesthesia, and (2) prospectively evaluate its initial feasibility, safety, and vascular outcomes in a consecutive series of patients.
This study was approved by the Institutional Review Board of Bach Mai Hospital, Hanoi, Vietnam (No. 6348/QĐ-BM). Written informed consent was obtained from all participants.
Description of Technique
The parallel percutaneous vascular closure technique was developed to achieve reliable hemostasis while preserving arterial lumen integrity following femoral decannulation in VA-ECMO patients. This method seeks to address the limitations of the traditional cross-stitch closure, particularly the risk of vessel narrowing and suture maldeployment, by aligning closure sutures in a true parallel configuration.
After ECMO flow discontinuation and confirmation of hemodynamic stability, two 0.035-inch guidewires were introduced through separate punctures in the side wall of the indwelling arterial cannula, spaced approximately 3–5 mm apart longitudinally. The arterial cannula was then carefully withdrawn and manual compression was applied approximately 2–3 cm proximal to the arterial puncture site to reduce back-bleeding during wire exchange and device insertion.
Two Perclose ProGlide devices (Abbott Vascular) were sequentially advanced over the guidewires into the femoral artery. Both devices were oriented at the 12 o’clock position, allowing for parallel suture alignment within the anterior arterial wall. The first device was deployed and the suture tied loosely to achieve partial closure. Once hemostasis was verified clinically, the second suture was deployed and tied in the same orientation to complete the closure (Figure 1). Using identical orientation minimizes crossing suture vectors, thereby reducing the risk of arterial distortion or stenosis. The procedure was deemed technically successful if complete hemostasis was achieved without adjunctive compression or surgical conversion. Following closure, guidewires were withdrawn, and standard skin closure was performed (Figure 2).
Patient Series
Between March 2024 and March 2025, a total of 36 consecutive adult patients (aged ≥18 years) who underwent VA-ECMO via percutaneous femoral arterial cannulation at the Center for Critical Care Medicine, Bach Mai Hospital were screened for eligibility. Of these, six patients were excluded: one due to severe peripheral arterial disease and five due to prior surgical intervention at the cannulation site.
The remaining 30 patients were included in this prospective case series (Figure 3). All 30 patients were successfully weaned off ECMO support and met the predefined criteria for hemodynamic stability prior to decannulation, including complete discontinuation of vasopressors and a serum lactate level below 2.0 mmol/L. The exclusion criteria applied during screening were as follows: Absolute contraindications included active local infection at the cannulation site; presence of a significant hematoma or uncontrolled bleeding at the access site prior to decannulation; a puncture site located above the inguinal ligament as determined by clinical assessment of anatomical landmarks; and known or suspected puncture through the posterior arterial wall or the presence of multiple punctures at the same access site. Additionally, relative contraindications that required careful, experienced operator judgment were also considered, including calcification of the common femoral artery at the access site [9]. Decannulation using the parallel closure technique was performed under a standardized protocol by two interventional physicians experienced with suture-mediated closure.
All procedures were conducted under sterile conditions in the intensive care unit (ICU) room. Each patient underwent percutaneous decannulation using the parallel closure technique as detailed above. Clinical data collected included demographic characteristics, ECMO indication and duration, technical success (defined as complete hemostasis without the need for surgical conversion), and the occurrence of vascular complications. All patients underwent vascular ultrasound assessment after ECMO decannulation to evaluate distal arterial flow at the cannulation site.
The primary technical endpoint was technical success, defined as achieving complete hemostasis at the arterial access site without the need for adjunctive manual compression, additional vascular intervention, or conversion to open surgical repair. All patients underwent standardized duplex Doppler ultrasound examination 24 hours after the procedure, performed by an experienced vascular sonographer. The protocol included B-mode imaging to assess for intraluminal thrombus, intimal dissection flaps, and peri-vascular hematoma, followed by color and pulsed-wave Doppler of the common femoral, superficial femoral, and profunda femoris arteries to evaluate flow velocity and patency.
All 30 patients underwent percutaneous femoral artery cannulation using a 16.5-French arterial cannula and were decannulated with the parallel closure technique using Perclose ProGlide devices. Thirteen patients (43.3%) were male. ECMO indications included myocardial infarction (43.3%), acute myocarditis (30%), cardiac arrest (16.7%), massive pulmonary embolism (6.7%), and fulminant dengue myocarditis (3.3%). Left femoral artery access was used in 76.7% of cases, while the right was used in 23.3%. Eighteen patients had distal perfusion catheters (DPCs) in place. Pre-decannulation coagulation parameters were within normal range (mean international normalized ratio, 1.17; mean aPTT, 40 seconds; mean platelet count, 103 ×109/L). Mean ECMO duration was 5.8 days (Table 1).
All procedures were performed bedside in a dedicated ICU operating room under local analgesia. The parallel closure technique was applied in all patients, using Perclose ProGlide devices oriented at the 12 o’clock position to achieve side-by-side suture alignment. In 90% of patients, vascular closure was successfully achieved with only two devices. No patient required reintervention or developed clinical limb ischemia during the 24-hour follow-up period.
Technical success was achieved in all cases (100%) without the need for surgical conversion or adjunctive vascular intervention. At 24 hours post-decannulation, duplex Doppler ultrasound demonstrated normal arterial flow in 23 patients (76.7%). Vascular complications included arterial thrombosis in five patients (16.7%), arterial dissection in one patient (3.3%), and arterial hematoma in one patient (3.3%) (Table 2). Subgroup comparison showed similar procedural results in survivors and non-survivors, despite differences in vasopressor use (Table 3).
Subgroup analysis demonstrated variations in arterial thrombosis rates across different clinical and procedural categories (Table 4). Among ECMO indications, arterial thrombosis occurred in two of five patients with cardiac arrest (40.0%), two of nine with acute myocarditis (22.2%), and one of 13 with myocardial infarction (7.7%). No cases of thrombosis were observed in patients with pulmonary embolism (n=2) or fulminant dengue myocarditis (n=1). According to arterial access site, thrombosis was identified in two of seven patients with right femoral cannulation (28.6%) and in three of 23 patients with left femoral cannulation (13.0%). Regarding closure technique, arterial thrombosis was detected in one of three patients (33.3%) who required three Perclose ProGlide devices, compared with four of 27 patients (14.8%) closed with two devices.
Achieving effective hemostasis during large-bore arterial decannulation remains a technical challenge, particularly in critically ill patients. Our findings suggest that the parallel suture technique is both feasible and safe when performed under local anesthesia at bedside. Technical success was achieved in all cases, with no need for surgical conversion or additional vascular interventions.
The use of a parallel suture configuration likely contributed to improved arterial wall apposition and reduced the risk of suture malalignment compared to traditional cross-stitch methods. Despite performing decannulation entirely bedside under local anesthesia, we observed normal arterial flow in 76.7% of patients, with a relatively low incidence of vascular complications—including arterial thrombosis (16.7%), dissection (3.3%), and hematoma (3.3%)—without the need for reintervention. These findings support the technique’s potential applicability in critically ill patients with minimal invasiveness. Importantly, all procedures were performed bedside under local anesthesia, which is a significant advantage in critically ill patients who may not be suitable candidates for transportation to an operating room or general anesthesia.
It is important to position our parallel post-closure technique within the context of other established suture-mediated strategies. The post-closure approach, notably described in the seminal work by Hwang et al. [4], has become a representative method for VA-ECMO decannulation. More recent innovations include pre-closure strategies, such as the “pre-anchoring and post-securing” technique reported by Lee et al. [8]. Our study builds upon the post-closure framework by specifically evaluating a parallel suture configuration, a refinement intended to address the potential limitations of conventional cross-suture placement, such as vessel distortion.
The reported 16.7% incidence of arterial thrombosis in our study is substantially lower than the 61.7% incidence reported by Trieu et al. [12] in their retrospective study of patients undergoing ECMO decannulation. In their analysis, cannula-associated arterial thrombosis was defined using a more comprehensive diagnostic strategy, including both (1) documentation of visible thrombus during surgical closure and (2) post-decannulation bedside duplex Doppler ultrasound detecting intraluminal thrombus with abnormal distal arterial flow. Their study population included patients treated with both surgical and percutaneous vascular closure: 21 of 47 patients (44.7%) underwent surgical closure, while 55.3% underwent percutaneous closure at bedside. Notably, the incidence of arterial thrombosis remained high in both groups: 51.7% in the surgical group and 48.3% in the percutaneous group [12]. These findings suggest that conventional closure methods alone may not sufficiently mitigate thrombotic risk. In contrast, the parallel suture technique, with its emphasis on geometric precision and controlled apposition, may represent a promising alternative for improving vascular outcomes.
A key finding of our study is the 16.7% incidence of arterial thrombosis which, while lower than some retrospective series, remains a clinically significant event that warrants further investigation. Our subgroup analysis (Table 4) offered potential insight into the underlying pathophysiology and highlighted potential risk factors that have been underexplored. First, we observed a higher rate of thrombosis with right-sided femoral access compared to left-sided access (28.6% vs. 13.0%). While our study is not powered to establish causality, this finding may reflect underlying anatomical differences. The right iliofemoral axis often has a more angulated path from the descending aorta, which could lead to more challenging cannulation, greater vessel trauma, and altered post-decannulation hemodynamics, potentially predisposing patients to thrombosis. Second, and counterintuitively, thrombosis was more frequent in patients who had a DPC in place (22.2% vs. 8.3%). While DPCs are essential for preventing limb ischemia, this observation may be explained by the creation of a “low-flow space” in the native artery, specifically in the segment between the large-bore arterial return cannula and the smaller, distally-directed DPC. This area of reduced blood flow and shear stress can become a nidus for thrombus formation, a phenomenon that has been described as a key risk factor for arterial thrombosis. Our clinical finding may provide important corroboration for this hemodynamic theory. These observations should be considered hypothesis-generating and underscore the need for larger, prospective studies to confirm these potential risk factors and to optimize strategies for thrombosis prevention in this complex patient population.
The type of closure strategy—whether manual compression, surgical repair, or percutaneous device—also appears to influence thrombotic outcomes. A meta-analysis by Mahalwar et al. [13] demonstrated no significant differences between suture-based systems and plug-based systems in terms of bleeding events, major or minor vascular complications, or pseudoaneurysm formation. The findings suggest that while both systems are viable options, their comparative effectiveness in thrombosis prevention remains inconclusive. In our practice, standardized parallel alignment may reduce turbulent flow and better preserve vessel lumen integrity than conventional cross-stitch configurations. Future studies comparing geometry-guided closure strategies (e.g., angio-guided or intravascular imaging-guided decannulation) are needed to clarify these effects. While our parallel percutaneous closure technique demonstrates promise, it is important to position it within the current landscape of VA-ECMO decannulation strategies and to define its role alongside alternative options. Open surgical repair remains the traditional standard and is an essential approach for patients with contraindications to percutaneous closure [9]. At our institution, surgical closure is the primary method for patients who underwent initial surgical cannulation, or in cases involving a puncture site located above the inguinal ligament, active infection, or significant bleeding at the access site. Furthermore, surgical closure serves as the indispensable fallback strategy in the event of percutaneous technique failure, and the immediate availability of a vascular surgeon is a prerequisite for all percutaneous decannulation procedures. In rare, emergent situations where percutaneous closure fails and there is a delay in surgical intervention, manual compression may be used as a temporary bridging measure to control bleeding while awaiting definitive surgical repair. However, it is important to clarify that manual compression is not employed at our center as a standalone method for definitive hemostasis of large-bore arteriotomy based on concerns regarding its limited efficacy and the associated risks of pseudoaneurysm formation, limb ischemia, and arterial thrombosis. Regarding other percutaneous options, plug-based vascular closure devices are not currently available in Vietnam; therefore, we have no institutional experience with this modality. The choice of decannulation strategy should thus be tailored to patient anatomy, the clinical scenario, and institutional resources and expertise.
One limitation of this study is that our vascular assessment was limited to a single duplex Doppler ultrasound performed 24 hours post-procedure. This short follow-up interval precludes the assessment of delayed vascular complications such as late thrombosis, pseudoaneurysm, or progressive arterial stenosis. Furthermore, the optimal approach for thrombosis surveillance following decannulation remains undefined. Although current protocols commonly utilize duplex Doppler ultrasound, this modality may fail to detect asymptomatic or proximally located thrombi. This limitation underscores the need to consider more sensitive imaging strategies—such as serial duplex assessments or computed tomographic angiography—particularly in patients at elevated risk. To address these gaps, we advocate that survivors of VA-ECMO should undergo regular, scheduled follow-up with a cardiology specialist. Crucially, this follow-up should extend beyond cardiac function to include a systematic clinical and imaging-based assessment of the vascular access site. Such a protocol is essential for monitoring and documenting any subacute or late complications that may arise. Ultimately, prospective, long-term studies are needed to systematically evaluate the arterial status of these patients over time. These studies will provide data to definitively establish the long-term efficacy and safety of percutaneous closure techniques.
Several other limitations to this study should be acknowledged. First, the absence of a control group precludes direct comparison with surgical or other percutaneous closure techniques. Second, the modest sample size (n=30) may not be sufficient to capture rare adverse events. Finally, and of importance to the interpretation of our results, all procedures were performed at a single high-volume ECMO center by two interventional physicians with extensive prior experience in large-bore percutaneous vascular closure. This high level of operator expertise undoubtedly contributed to the 100% technical success rate observed and may not be immediately generalizable to centers with less experience. There is a well-established learning curve associated with suture-mediated closure devices, and procedural success rates often improve while complication rates decrease as operators gain proficiency. Therefore, the outcomes reported in our series should be interpreted within this context. We recommend that institutions seeking to adopt this technique do so with a structured training program, potentially including proctoring by experienced operators, to mitigate risks during the initial adoption phase.
Overall, our findings suggest that parallel percutaneous closure technique may have a protective effect against arterial thrombosis by optimizing closure geometry and limiting iatrogenic injury during decannulation. This potential benefit warrants further prospective validation. Future studies should aim to (1) standardize thrombosis assessment protocols using both imaging and clinical endpoints, (2) compare specific closure techniques head-to-head (e.g., parallel configuration vs. cross-suture configuration vs. surgical closure), and (3) explore mechanistic correlations such as flow dynamics and vessel wall healing using advanced imaging or histopathologic models. Given the clinical significance of arterial thrombosis in ECMO survivors, refinement of decannulation strategies represents a key step toward improving long-term vascular outcomes in this population.
In summary, further prospective studies with standardized protocols and long-term follow-up are necessary to confirm the safety and efficacy of parallel percutaneous closure. Until such data are available, routine adoption should be considered in centers with appropriate expertise and infrastructure.
▪ The parallel closure technique appears technically feasible for femoral artery decannulation after venoarterial extracorporeal membrane oxygenation.
▪ Initial experience suggests an acceptable safety profile with few early complications.
▪ Bedside application under local anesthesia may offer practical advantages in critically ill patients.

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported, and no financial support was received from Abbott Vascular or any other device manufacturer.

FUNDING

This study was supported by the Center for Critical Care Medicine, Bach Mai Hospital, Vietnam.

ACKNOWLEDGMENTS

The authors would like to thank BioRender.com for providing the tools used to create the illustrations in this manuscript.

AUTHOR CONTRIBUTIONS

Conceptualization: VHN, HGTB. Methodology: VHN, HGTB, NSD, QTD, TTP, CTN, BCN. Formal analysis: VHN, QTD, CTN, BCN, HGN, TDN. Data curation: VHN, BCN, HGN, TDN. Visualization: VHN. Project administration: XCD. Funding acquisition: BCN. Writing – original draft: VHN, HGTB. Writing – review & editing: VHN, NSD, QTD, TTP, CTN, BCN. All authors read and agreed to the published version of the manuscript.

Figure 1.
Schematic illustration of the parallel percutaneous vascular closure technique using two Perclose ProGlide devices during extracorporeal membrane oxygenation (ECMO) decannulation. VA-ECMO: veno-arterial ECMO. Created with BioRender.com.
acc-002675f1.jpg
Figure 2.
Flowchart summarizing procedural steps and post-closure assessment and management of the parallel closure technique. ECMO: extracorporeal membrane oxygenation.
acc-002675f2.jpg
Figure 3.
Patient flow diagram.
acc-002675f3.jpg
Table 1.
Characteristics of the study population
Characteristics Value (n=30)
Age (yr) 50±20
Sex (male) 13 (43.3)
ECMO mode
 VA-ECMO 30 (100)
 VAV-ECMO 0
Diagnosis for ECMO
 Myocardial infarction 13 (43.3)
 Acute myocarditis 9 (30.0)
 Cardiac arrest 5 (16.7)
 Massive pulmonary embolism 2 (6.7)
 Fulminant dengue myocarditis 1 (3.3)
Arterial cannulation site
 Left common femoral artery 23 (76.7)
 Right common femoral artery 7 (23.3)
Distal perfusion catheter 18 (60.0)
Duration of ECMO (day) 5.8±2.7
Coagulation status before decannulation
 INR 1.17±0.18
 aPTT (sec) 40.0±9.9
 Platelets (×10⁹/L) 103±28
Number of devices
 Number of Perclose ProGlide devices 2 (2–3)
 Number of patients using two devices 27 (90)
 Number of patients using three devices 3 (10)

Values are presented as mean±standard deviation, number (%), or median (range).

ECMO: extracorporeal membrane oxygenation; VA-ECMO: veno-arterial ECMO; VAV-ECMO: veno-arterial-venous ECMO; INR: international normalized ratio; aPTT: activated partial thromboplastin time.

Table 2.
Complications and outcomes of the study population
Value (n=30)
Norepinephrine requirement 13 (43.3)
RBC transfusion requirement 2 (0–4)
ICU stay after ECMO removal (day) 15.4±10.5
Survival to discharge 25 (83.3)
Normal post-decannulation arterial flow as assessed by duplex Doppler 23 (76.7)
Arterial complications
 Arterial thrombosis 5 (16.7)
 Arterial dissection 1 (3.3)
 Arterial hematoma 1 (3.3)
The need for additional vascular or surgical intervention 0

Values are presented as number (%), median (range), or mean±standard deviation.

RBC: red blood cell; ICU: intensive care unit; ECMO: extracorporeal membrane oxygenation.

Table 3.
Comparison between survivors and non-survivors following ECMO decannulation using the parallel closure technique
Survivor (n = 25) Non-survivor (n = 5)
Diagnosis for ECMO
 Myocardial infarction 10 3
 Acute myocarditis 9 0
 Cardiac arrest 3 2
 Massive pulmonary embolism 2 0
 Fulminant dengue myocarditis 1 0
Duration of ECMO (day) 5.7±2.8 6.0±2.6
Coagulation Status before decannulation
 INR 1.17±0.19 1.17±0.08
 aPTT (sec) 41.4±9.9 35.7±9.7
 Platelets (×10⁹/L) 105±30 93±20
Parallel percutaneous vascular closure technique
 Number of Perclose ProGlide devices 2 (2–3) 2 (2–2)
 Norepinephrine requirement 10 (40.0) 3 (60.0)
 RBC transfusion requirement 2 (0–4) 2 (0–4)

Values are presented as mean±standard deviation, median (range), or number (%).

ECMO: extracorporeal membrane oxygenation; INR: international normalized ratio; aPTT: activated partial thromboplastin time.

Table 4.
Incidence of arterial thrombosis according to subgroups
Subgroup Number of patients Patients with arterial thrombosis
Diagnosis for ECMO
 Myocardial infarction 13 1 (7.7)
 Acute myocarditis 9 2 (22.2)
 Cardiac arrest 5 2 (4.0)
 Massive pulmonary embolism 2 0
 Fulminant dengue myocarditis 1 0
Arterial cannulation site
 Left femoral 23 3 (13.0)
 Right femoral 7 2 (28.6)
Distal perfusion catheter present 18 4 (22.2)
Distal perfusion catheter absent 12 1 (8.3)
Number of Perclose devices
 Two devices 27 4 (14.8)
 Three devices 3 1 (33.3)

Values are presented as number (%).

ECMO: extracorporeal membrane oxygenation.

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        Percutaneous vascular closure technique using parallel closure in extracorporeal membrane oxygenation decannulation: technical note and case series
        Acute Crit Care. 2026;41(2):335-343.   Published online April 17, 2026
        DOI: https://doi.org/10.4266/acc.002675
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      Percutaneous vascular closure technique using parallel closure in extracorporeal membrane oxygenation decannulation: technical note and case series
      Image Image Image
      Figure 1. Schematic illustration of the parallel percutaneous vascular closure technique using two Perclose ProGlide devices during extracorporeal membrane oxygenation (ECMO) decannulation. VA-ECMO: veno-arterial ECMO. Created with BioRender.com.
      Figure 2. Flowchart summarizing procedural steps and post-closure assessment and management of the parallel closure technique. ECMO: extracorporeal membrane oxygenation.
      Figure 3. Patient flow diagram.

      Figure 1.

      Figure 2.

      Figure 3.

      Percutaneous vascular closure technique using parallel closure in extracorporeal membrane oxygenation decannulation: technical note and case series
      Characteristics Value (n=30)
      Age (yr) 50±20
      Sex (male) 13 (43.3)
      ECMO mode
       VA-ECMO 30 (100)
       VAV-ECMO 0
      Diagnosis for ECMO
       Myocardial infarction 13 (43.3)
       Acute myocarditis 9 (30.0)
       Cardiac arrest 5 (16.7)
       Massive pulmonary embolism 2 (6.7)
       Fulminant dengue myocarditis 1 (3.3)
      Arterial cannulation site
       Left common femoral artery 23 (76.7)
       Right common femoral artery 7 (23.3)
      Distal perfusion catheter 18 (60.0)
      Duration of ECMO (day) 5.8±2.7
      Coagulation status before decannulation
       INR 1.17±0.18
       aPTT (sec) 40.0±9.9
       Platelets (×10⁹/L) 103±28
      Number of devices
       Number of Perclose ProGlide devices 2 (2–3)
       Number of patients using two devices 27 (90)
       Number of patients using three devices 3 (10)
      Value (n=30)
      Norepinephrine requirement 13 (43.3)
      RBC transfusion requirement 2 (0–4)
      ICU stay after ECMO removal (day) 15.4±10.5
      Survival to discharge 25 (83.3)
      Normal post-decannulation arterial flow as assessed by duplex Doppler 23 (76.7)
      Arterial complications
       Arterial thrombosis 5 (16.7)
       Arterial dissection 1 (3.3)
       Arterial hematoma 1 (3.3)
      The need for additional vascular or surgical intervention 0
      Survivor (n = 25) Non-survivor (n = 5)
      Diagnosis for ECMO
       Myocardial infarction 10 3
       Acute myocarditis 9 0
       Cardiac arrest 3 2
       Massive pulmonary embolism 2 0
       Fulminant dengue myocarditis 1 0
      Duration of ECMO (day) 5.7±2.8 6.0±2.6
      Coagulation Status before decannulation
       INR 1.17±0.19 1.17±0.08
       aPTT (sec) 41.4±9.9 35.7±9.7
       Platelets (×10⁹/L) 105±30 93±20
      Parallel percutaneous vascular closure technique
       Number of Perclose ProGlide devices 2 (2–3) 2 (2–2)
       Norepinephrine requirement 10 (40.0) 3 (60.0)
       RBC transfusion requirement 2 (0–4) 2 (0–4)
      Subgroup Number of patients Patients with arterial thrombosis
      Diagnosis for ECMO
       Myocardial infarction 13 1 (7.7)
       Acute myocarditis 9 2 (22.2)
       Cardiac arrest 5 2 (4.0)
       Massive pulmonary embolism 2 0
       Fulminant dengue myocarditis 1 0
      Arterial cannulation site
       Left femoral 23 3 (13.0)
       Right femoral 7 2 (28.6)
      Distal perfusion catheter present 18 4 (22.2)
      Distal perfusion catheter absent 12 1 (8.3)
      Number of Perclose devices
       Two devices 27 4 (14.8)
       Three devices 3 1 (33.3)
      Table 1. Characteristics of the study population

      Values are presented as mean±standard deviation, number (%), or median (range).

      ECMO: extracorporeal membrane oxygenation; VA-ECMO: veno-arterial ECMO; VAV-ECMO: veno-arterial-venous ECMO; INR: international normalized ratio; aPTT: activated partial thromboplastin time.

      Table 2. Complications and outcomes of the study population

      Values are presented as number (%), median (range), or mean±standard deviation.

      RBC: red blood cell; ICU: intensive care unit; ECMO: extracorporeal membrane oxygenation.

      Table 3. Comparison between survivors and non-survivors following ECMO decannulation using the parallel closure technique

      Values are presented as mean±standard deviation, median (range), or number (%).

      ECMO: extracorporeal membrane oxygenation; INR: international normalized ratio; aPTT: activated partial thromboplastin time.

      Table 4. Incidence of arterial thrombosis according to subgroups

      Values are presented as number (%).

      ECMO: extracorporeal membrane oxygenation.

      Table 1.

      Table 2.

      Table 3.

      Table 4.

      ACC : Acute and Critical Care
      © The Korean Society of Critical Care Medicine.
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