74: Artery Morphology Following Peripheral Arterial Cannulation in Neonates and Children

Background: Arterial decannulation after extracorporeal life support (ECLS) is addressed variably, with carotid arteries either ligated or reconstructed and femoral artery cannulation sites closed either primarily or with patch repair. We sought to characterize arterial morphology following decannulation in pediatric patients, focusing on arterial thrombosis or narrowing, or intimal changes with presumed long-term risk of flow alteration. Methods: Retrospective chart review of patients undergoing peripheral arterial cannulation from 2002-2022 at a tertiary care, free-standing children’s hospital. The primary outcome of interest was any arterial anomaly after decannulation with arterial reconstruction. Results: Peripheral arterial cannulation accounted for 431 cannulations (393 carotid and 38 femoral). Among the carotid group survivors, 103 (33.4%) underwent carotid artery reconstruction; 45 (43.7%) of this group had post-operative imaging (median interval 21 days, IQR 4-50 days) and 21 (46.7%) had arterial morphologic changes. Among the femoral artery survivors, 24 (100%) underwent femoral artery reconstruction (12 primarily, 12 with autologous venous patch repair). 22 (91.7%) had post-operative imaging (interval median 9 days, IQR 4-22 days) and 7 (31.8%) of these showed arterial morphologic anomalies. In the carotid group, neonates were associated with higher odds of abnormal arterial morphology than older patients when adjusting for sex and ECLS duration (OR 6.3; 95% CI: 1.49-26.3). Conclusions: Arterial reconstruction following decannulation of peripheral arterial ECLS in pediatric patients is accompanied by a significant risk for acquired vessel morphologic changes and rigorous long-term follow-up should be standard practice.