Full percutaneous decannulation of VA-ECMO using MANTA® and Femoseal® devices: a propensity-score based study

Full percutaneous decannulation of VA-ECMO using MANTA® and Femoseal® devices: a propensity-score based study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Full percutaneous decannulation of VA-ECMO using MANTA® and Femoseal® devices: a propensity-score based study Elodie Berg, Charles juvin, Marc Pineton de Chambrun, Charifa Nazoiri, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8722162/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Apr, 2026 Read the published version in Critical Care → Version 1 posted 7 You are reading this latest preprint version Abstract Background Percutaneous veno-arterial extracorporeal membrane oxygenation (VA-ECMO) implantation reduces infectious complications compared with surgical cannulation. However, arterial decannulation using manual compression remains associated with bleeding, vascular injury, and infection. We evaluated a fully percutaneous decannulation strategy (FP-D) combining MANTA® and Femoseal® devices. Methods All patients undergoing FP-D between October 2020 and May 2022 in our institution were included. Outcomes were compared with a historical cohort decannulated using manual compression (MC). The primary endpoint was surgical revision after decannulation. Secondary endpoints included major bleeding, transfusion, vascular complications, infection, and 30-day survival. A propensity score weighting approach was performed to adjust for baseline differences. Results Among 497 patients treated with percutaneous VA-ECMO, 250 underwent FP-D and 247 MC. After propensity score, FP-D significantly reduced surgical revision (3.9% vs 7.2%; RR 0.55, 95% CI 0.32–0.94; p = 0.0311), infection requiring surgery (3.7% vs 8.4%; RR 0.44, 95% CI 0.25–0.77; p = 0.004), and major bleeding (1.4% vs 11%; RR 0.13, 95% CI 0.06–0.30; p < 0.0001), with lower transfusion requirements (7.1% vs 45.7%; RR 0.16, 95% CI 0.11–0.22; p < 0.0001). Thirty-day survival was comparable between groups (91.8% vs 94.7%; p = 0.11). Systematic CT scans revealed frequent but mostly silent arterial lesions after FP-D. Conclusion FP-D markedly reduced bleeding, transfusion, infection, and surgical revision compared with manual compression, while preserving short-term survival. Systematic imaging identified frequent subclinical vascular lesions, supporting targeted surveillance and endovascular management when appropriate. Extracorporeal Membrane Oxygenation Decannulation Vascular Closure Devices Hemostasis Complications TAKE HOME MESSAGE Full-percutaneous VA-ECMO decannulation reduced bleeding, transfusion, re-operation, and deep infection compared with manual compression, without affecting survival. Systematic imaging revealed frequent silent arterial lesions, highlighting the need for targeted surveillance and endovascular management. Introduction Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a life-saving therapy for refractory cardiogenic shock [ 1 , 2 ]. While percutaneous cannulation reduces infectious complications compared with surgical access (16.5 vs. 27.8%, p < 0.001) with a better 30-day survival [ 3 ], However, arterial decannulation remains a critical step: manual compression, the current standard, carries a substantial risk of bleeding, vascular injury, and infection, often requiring surgical revision. These complications may offset the benefits of percutaneous cannulation [ 3 ]. To address these limitations, we developed a fully percutaneous decannulation technique (FP-D) combining the MANTA® vascular closure device for the arterial cannula and Femoseal® for the reperfusion cannula [ 4 ]. We hypothesized that FP-D would reduce bleeding and infectious complications compared with manual compression, without impairing short-term survival. Methods Study design and population We conducted a single-center retrospective study at Pitié-Salpêtrière Hospital (Paris, France). All patients supported with percutaneous femoro-femoral VA-ECMO between October 2020 and May 2022 and decannulated using the fully percutaneous decannulation (FP-D) technique were included. FP-D patients were compared with a historical cohort decannulated using manual compression (MC), before FP-D implementation. Demographic, perioperative, and outcome data were collected from electronic medical records and institutional registries. The database was approved by the French National Data Protection Authority (CNIL, reference 4Lj17203757). The study was approved by the Ethics Comitee of the French Society of thoracic and cardiovascular surgery (SFCTCV, IRB00012919). The study complied with the Declaration of Helsinki; informed consent was waived according to French law. Decannulation techniques FP-D consisted of closure of the arterial cannula with the MANTA® device and the reperfusion cannula with Femoseal®., as previously described by our team [ 4 ]. In the MC group, decannulation was achieved by manual compression at the cannulation site. FP-D failure was defined as the need for secondary manual compression and/or surgical revision. Outcomes The primary outcome was surgical revision after decannulation. Secondary outcomes included FP-D failure—defined as the need for manual compression and/or surgical revision following decannulation—and vascular complications. These complications comprised severe bleeding (defined as bleeding associated with a drop in hemoglobin ≥ 3.0 g/dL, or requiring transfusion of ≥ 2–3 units of whole blood or red blood cells, or resulting in hospitalization, permanent injury, or surgery without meeting the criteria for life-threatening or disabling bleeding, as defined by the VARC-2 consensus [ 5 ]), cannulation site infections, arterial dissections and thrombosis. Asymptomatic vascular complications related to cannulation (i.e., incidental findings) were assessed through review of follow-up CT scans, including dissection lesions extending to the external iliac arteries. Additional recorded outcomes included neurological complications, compartment syndrome requiring fasciotomy, and limb amputations. Statistical analysis Continuous variables are expressed as means ± standard deviations or medians (interquartile range) and were compared with Student’s t test or Wilcoxon rank sum test, as appropriate. Categorical variables are expressed as percentages and were compared using chi-squared tests. Clinical endpoints were compared between MANTA® and compression groups using propensity score (PS) framework. Patients for whom ECMO removal was performed as part of end-of-life care in the context of terminal cardiac disease were excluded from the propensity score analysis The PS approach aims at creating a new dataset in which the probability to MANTA® or compression weaning ECMO is equal (as in a pure randomized trial) to balance patients’ baseline characteristics. MANTA® and compression group patients were compared using PS weighting. The propensity score, representing the probability of a patient receiving the MANTA® device given their baseline characteristics, was estimated using logistic regression. Variables included in the propensity score model were: age, sex, BMI, smoking, hypercholesterolemia, arterial hypertension, and indication of VA ECMO. To estimate the causal treatment effect, we utilized overlap weights. This method weights each patient by the inverse probability of their actual treatment weighted by the probability of receiving the opposite treatment, which estimates the average treatment effect in the population with maximum overlap in propensity scores. Covariate balance between the two groups was assessed after weighting, and we considered an absolute standardized difference less than 0.1 as evidence of adequate balance[ 6 ]. Then, clinical endpoints were compared between MANTA® and compression groups within the weighted dataset. Overlap weighting assigns weights proportional to the probability of receiving the opposite treatment. Individuals who receive the actual treatment are weight by 1 minus their PS, and those who received the opposite treatment are weighted by their PS [ 7 ]. Overall survival until day 30 was estimated in the two groups by the Kaplan–Meier method in the weighted sample. A p value < 0.05 was considered statistically significant. Statistical analyzes were conducted with R v3.5.1. Results FP-D group results Patients Among the 263 patients weaned from VA-ECMO using the FP-D technique, 20 (7.6%) experienced procedural failure requiring secondary manual compression. Obesity (median BMI 29 vs 25, p = 0.0071) and diabetes (40% vs 15.6%, p = 0.0116) were significantly associated with FP-D failure (Table 1 ). Table 1 Baseline characteristics of the FP-D group. FP-D group Overall 263 (100%) Failure 20 (7.60%) Sucess 243 (92.40%) pValue Age, years Median [Q1, Q3] 53 [38, 63] 57[44, 63.5] 52 [38, 63] 0.4884 Female 74 (28.1%) 5 (25.00%) 69 (28.40%) 0.7455 BMI, Kg/m 2 Median [Q1, Q3] 25.4 [22.55, 29.07] 29.01 [24.59, 34.14] 25.15 [22.49, 28.6] 0.0071 Smoking 109 (41.4%) 12 (60.0%) 97 (39.9%) 0.0797 Hypercholesterolemia 49 (18.6%) 7 (35.0%) 42 (17.2%) 0.0691 Diabetes mellitus 46 (17.5%) 8 (40.0%) 38 (15.6%) 0.0116 Arterial hypertension 78 (29.7%) 9 (45.0%) 69 (28.4%) 0.1181 Peripheral artery disease 10 (3.8%) 2 (10.0%) 8 (3.3%) 0.1711 Creatinine 0.2177 Median [Q1, Q3] 113 [78.00, 169.00] 128 [99.00, 157.00] 110 [72, 172] Therapy plan 0.77 Bridge to recovery 245 (93.2%) 19 (95.0%) 226 (93.0%) Bridge to intervention 9 (3.4%) 1 (5.0%) 8 (3.3%) Resuscitation 9 (3.4%) 0 (0%) 9 (3.7%) Etiology of Cardiac Shock 0.35 Post cardiotomy CS 51 (19.39%) 3 (15.00%) 48 (19.75%) Primary graft failure 38 (14.45%) 5 (25.00%) 33 (13.58%) MI-related CS 58 (22.05%) 7 (35.00%) 51 (20.99%) Dilated cardiopathy 20 (7.60%) 1 (5.00%) 19 (7.82%) Myocarditis 34 (12.93%) 1 (5.00%) 33 (13.58%) Heart-Kidney transplantation 6 (2.28%) 1 (5.00%) 5 (2.06%) Post partum cardiopathy 8 (3.04%) 1 (5.00%) 7 (2.88%) Others 48 (18.25%) 1 (5.00%) 47 (19.34%) Clinical outcomes after decannulation are summarized in Table 2 . Arterial cannula diameter was not associated with failure (p = 0.17). The mean duration of ECMO support was 8 days (maximum 47 days), and did not differ significantly between patients with successful decannulation and those with failure (8.3 vs 11.7 days, p = 0.075). FP-D failure was strongly associated with major bleeding (35% vs 0.4%, p < 0.0001) and with transfusion (31.6% vs 0.9%, p < 0.0001). MANTA failure was significantly associated with surgical reoperation (50% vs 4.7%, p < 0.0001). In cases of MANTA failure, subsequent interventions were mostly performed using an open surgical approach (60%), whereas secondary MANTA-related complications were predominantly managed percutaneously (63.6%). The mean follow-up was 204 days. Two early deaths, likely due to hemorrhagic shock, occurred shortly after decannulation; both events arose early in the learning curve. Table 2 Clinical outcomes in the FP-D group. MANTA® Overall n = 263 (100%) Failure, n = 20 (7.60%) Success, n = 243 (92.40%) p value Arterial cannula size 0.124 17Fr 23 cm 188 (71.5%) 14 (70.0%) 174 (71.6%) 15Fr 23cm 9 (3.4%) 1 (5.0%) 8 (3.3%) 19Fr 23cm 52 (19.8%) 2 (10.0%) 50 (20.6%) Others 14 (5.3%) 3 (15.0%) 11 (4.5%) ECMO Duration, days 8.3 (6.53) 11.7 (6.67) 8.02 (6.15) 0.075 Limb Acute ischemia 5 (2.0%) 2 (10.0%) 3 (1.3%) 0.0507 Major Bleeding 8 (3.1%) 7 (35.0%) 1 (0.4%) < 0.0001 Infection 17 (6.7%) 3 (15.0%) 14 (6.0%) 0.138 Lymphorrhea 2 (0.8%) 2 (10.0%) 0 (0%) 0.0061 Peripheral neurological complication 1 (0.4%) 0 (0%) 1 (0.4%) 1.00 Surgical revision 21 (8.2%) 10 (50.0%) 11 (4.7%) < 0.0001 Type of surgery 0.3949 Open 10 (47.6%) 6 (60.0%) 4 (36.4%) Endovascular 11 (52.4%) 4 (40.0%) 7 (63.6%) FP-D related transfusion* 8 (3.46%) 6 (31.58%) 2 (0.94%) < 0.0001 Subclinical arterial complication 68 (37.6%) 7 (46.7%) 61 (36.7%) 0.4474 Arterial complication secondary to cannulation 32 (22.1%) 3 (27.3%) 29 (21.6%) 0.7073 Evolution of arterial injury 1.00 Lesion improvement 11 (33.33%) 0 (0%) 11 (34.4%) Recovery 5 (15.2%) 0 (0%) 5 (15.6%) Persistence of injury 17 (51.5%) 1 (100.0%) 16 (50.0%) Death 1.00 All cause 81 (30.8%) 6 (30.0%) 75(30.9%) Death procedure-related 3(1.1%) 2(10.0%) 1(41.0%) *Transfusion required by FP-D complication (excluding transfusion related to other indications) CT-Scan follow-up Among the 180 patients (69%) who underwent systematic CT scanning after decannulation, 68 (38%) had asymptomatic arterial injuries. Vascular lesions related to intra-aortic balloon pump (IABP) use or arterial catheterization were identified in 12 patients (6.6%). One patient developed a false aneurysm of the superficial femoral artery, attributed to reperfusion cannula removal. Extensive external iliac artery lesions were present in 30 patients (16.6%). Incomplete thromboses with collateralization were observed in 17 patients (9.4%), while 13 patients had dissections extending to the common iliac artery but not involving the abdominal aorta. Focal lesions were detected in 26 patients (14.4%), including 11 cases (6.1%) attributed to cannulation too close to the femoral bifurcation. Four femoral stenoses (2.2%) were < 50% in severity, and the remaining 11 lesions (6.6%) were primarily focal dissections with associated thrombosis. Immediately after decannulation, 6 patients (3.3%) required surgical intervention, including 4 endovascular procedures. One additional patient underwent endovascular treatment after discharge from the intensive care unit. FP-D group vs MC group Between October 2020 and May 2022, 497 patients underwent percutaneous femoro-femoral VA-ECMO for refractory cardiogenic shock: 250 in the FP-D group and 247 in the MC group (propensity score, Table 3 ). Patients with surgical cannulation were excluded. Table 3 Patient Characteristics of the entire study cohort and after propensity-score analysis Before PS After PS MC group n = 247 (%) FP-D group n = 250 (%) P value MC group, n = 247 FP-D group, n = 250 Age,years 55 [43 ; 64] 52.5 [38 ; 63] 0.0889 52.667 (± 14.965) 52.667 (± 15.036) Female 81 (32.93%) 70 (28%) 0.2332 28.3 (± 0.451) 28.3 (± 0.451) BMI 25.3 [22.85 ; 29.2] 25.35 [22.72 ; 29.1] 0.9269 26.297 (± 6.422) 26.297 (± 5.011) Atherosclerosis factor Smoking 96 (38.87%) 103 (41.2%) 0.6211 42,7 (± 0.496) 42,7 (± 0.496) Arterial hypertension 135 (54.66%) 74 (29.6%) < 0.0001 40.5 (± 0.492) 40.5 (± 0.492) Dyslipidemia 82 (33.2%) 46 (18.4%) 0.0001 26.6 (± 0.443) 26.6 (± 0.443) Diabetes Mellitus 54 (21.86%) 40 (16%) 0.1137 19.4 (± 0.396) 19.4 (± 0.396) Etiology of Cardiac Shock 0.4935 Post cardiotomy 44 (17.81%) 50 (20%) 19.5 (± 0.397) 19.5 (± 0.397) Primary graft failure 67 (27.13%) 38 (15.20%) 19.7 (± 0.399) 19.7 (± 0.399) MI-related CS 45 (18.22%) 53 (21.2%) 22.3 (± 0.417) 22.3 (± 0.417) Dilated cardiopathy 43 (17.41%) 18 (7.2%) 10.3 (± 0.305) 10.3 (± 0.305) Myocarditis 8 (3.24%) 32 (12.8%) 6.2 (± 0.242) 6.2 (± 0.242) Others 40 (16.19%) 59 (23.6%) 22 (± 0.415) 22 (± 0.415) The main indications for short-term support were primary graft failure (27.13% in MC vs 15.2% in FP-D), acute myocardial infarction–related cardiogenic shock (18.22% vs 21.2%), and post-cardiotomy shock (17.81% vs 20.0%). Primary and secondary endpoints Post-decannulation events are summarized in Table 2 . The rate of revision surgery (all causes) was significantly lower in the FP-D group compared with MC (3.9% vs 7.2%; RR 0.55, 95% CI 0.32–0.95; p = 0.0311). Infections requiring surgery (3.7% vs 8.4%; RR 0.44, 95% CI 0.25–0.77; p = 0.004), major bleeding (1.4% vs 11%; RR 0.13, 95% CI 0.06–0.30; p < 0.0001), and transfusion requirements (7.2% vs 45.7%; RR 0.16, 95% CI 0.11–0.22; p < 0.0001) were also significantly lower in the FP-D group (Table 2 ). Acute limb ischemia tended to be less frequent with FP-D (1.2% vs 3.2%), although the difference was not statistically significant (RR 0.39, 95% CI 0.14–1.10; p = 0.0749). 30-day Survival Unadjusted 30-day survival was 84.8% in the FP-D group and 88.7% in the MC group (p = 0.20). After propensity score, survival remained similar (91.8% vs 94.5%; RR 1.49, 95% CI 0.89–2.50; p = 0.1316; Table 4 ). Table 4 VA-ECMO-related outcomes in the propensity score population MC Group (%) FP-D group (%) RR p value Transfusion 45.7% 7.2% 0.16 [0.11 ; 0.22] < 0.0001 Major bleeding 11% 1.4% 0.13[0.06 ; 0.3] < 0.0001 Infection 8.4% 3.7% 0.44 [0.25 ; 0.77] 0.004 Acute Limb Ischemia 3.2% 1.2% 0.39 [0.14 ; 1.1] 0.0749 surgical revision 7.2% 3.9% 0.55 [0.32 ; 0.95] 0.0311 30-day Survival 94.5% 91.8% 1.49 [0.89 ;2.5] 0.1316 Discussion In this large propensity score cohort, full percutaneous decannulation (FP-D) of femoro-femoral VA-ECMO using MANTA® and Femoseal® was associated with significantly fewer hemorrhagic and infectious complications compared with manual compression, while short-term survival remained comparable. FP-D failures were infrequent (7.6%) and mainly associated with obesity and diabetes. Importantly, systematic post-decannulation CT imaging revealed a high prevalence of asymptomatic arterial lesions, some requiring endovascular management. Our results are consistent with and extend prior reports on percutaneous ECMO decannulation. Proglide®-based strategies have been described with promising results in terms of limb ischemia reduction [ 8 ], but their applicability is limited in unstable patients requiring urgent cannulation, as pre-closure is often unfeasible. Moreover, prolonged device dwelling may increase infection risk [ 9 – 11 ]. In contrast, the FP-D technique using MANTA® provides immediate hemostasis at the time of decannulation without the need for pre-placement, which is particularly advantageous in ECMO runs of several days. Previous series of MANTA® for ECMO decannulation were small and lacked systematic imaging, limiting their ability to assess vascular sequelae [ 12 ]. By including over 250 patients and incorporating CT follow-up, our study adds robust evidence that FP-D reduces major morbidity without compromising survival. Moreover, the technique previously described [ 12 ] relies on ultrasound and the Pythagorean theorem to estimate the distance between the skin and the artery. However, such measurements are often unreliable because edema distorts the tissues and affects the calculation. One of the most striking findings of our study is the high incidence of subclinical arterial lesions identified by CT angiography. Although many dissections and non-occlusive thromboses remained clinically silent, several required endovascular repair, and the long-term significance of these lesions remains uncertain. Previous work from our group and others has suggested that up to 30% of ECMO patients may develop femoral artery thrombosis, often without symptoms [ 13 ]. Our results support systematic vascular imaging after decannulation to guide follow-up and early intervention when indicated. Such an approach could prevent late complications such as claudication, aneurysm formation, or chronic ischemia. The success of FP-D is highly dependent on optimal cannulation technique. Puncture too close to the femoral bifurcation increases the risk of focal stenosis or thrombosis, as observed in our series [ 12 ]. Ultrasound-guided puncture at an adequate distance from the bifurcation is therefore essential. FP-D also requires precise measurement of puncture depth, which can be challenging in the presence of edema [ 12 ]. Although two early fatal bleeding events occurred, they were clustered at the beginning of our experience, suggesting a learning curve effect. With growing familiarity, FP-D proved reproducible and safe in the majority of cases. Several limitations should be acknowledged. First, this was a single-center study in a high-volume ECMO program, which may limit external validity. Both complication and mortality data were prospectively collected, but some baseline and cannulation-related variables were retrospectively retrieved. Second, CT follow-up was incomplete (69%), potentially leading to underestimation of subclinical vascular lesions. Third, long-term outcomes of these lesions remain unknown. Finally, the use of MANTA® in this context is off-label [ 12 ], although our results support its feasibility and safety. Despite these limitations, our findings suggest that FP-D is a safe and effective alternative to manual compression, significantly reducing decannulation-related morbidity. By minimizing bleeding, transfusion, and infection, FP-D may contribute to improved outcomes in this fragile population. Moreover, systematic imaging after decannulation appears crucial to detect clinically silent but potentially significant arterial lesions. Future multicenter studies should confirm these results, assess cost-effectiveness, and determine whether vascular imaging surveillance should be incorporated into standard ECMO protocols. Conclusion Full percutaneous decannulation of VA-ECMO using MANTA® and Femoseal® significantly reduced bleeding, transfusion, infection, and surgical revision compared with manual compression, while preserving survival. The technique proved safe and reproducible, with a low failure rate. Systematic CT imaging revealed frequent but often silent arterial lesions, underscoring the importance of structured vascular surveillance and, when appropriate, endovascular management. These findings support FP-D as a valuable alternative to manual compression in high-volume ECMO programs. Future multicenter studies should confirm its generalizability and clarify the long-term impact of subclinical vascular lesions. Declarations Ethical Approval and Consent to participate The study was approved by the Ethics Comitee of the French Society of thoracic and cardiovascular surgery (SFCTCV, IRB00012919). The study complied with the Declaration of Helsinki; informed consent was waived according to French law. Consent for publication Not applicable Availability of supporting data No funding sources. Competing interests Authors declare that they have no conflict of interest. Funding Not applicable Authors' contributions Pr Lebreton designed the study and performed critical revisions of the manuscript. Dr Berg designed the tables and figures and wrote the manuscript. All authors gave critical comments on the manuscript and approved it for submission. All co-authors reviewed the manuscript Acknowledgements The authors wish to thank Pr Hajage for statistical analysis. References Combes A, Brodie D, Chen Y-S, et al. The ICM research agenda on extracorporeal life support. Intensive Care Med. 2017;43:1306–18. https://doi.org/10.1007/s00134-017-4803-3 . Ouweneel DM, Schotborgh JV, Limpens J, et al. Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis. Intensive Care Med. 2016;42:1922–34. https://doi.org/10.1007/s00134-016-4536-8 . Danial P, Hajage D, Nguyen LS, et al. Percutaneous versus surgical femoro-femoral veno-arterial ECMO: a propensity score matched study. Intensive Care Med. 2018;44:2153–61. https://doi.org/10.1007/s00134-018-5442-z . Juvin-Bouvier C, Nardone N, Berg E et al. (2023) Decannulation of Percutaneous Femoro-femoral VA-ECMO Using the Manta Vascular Closure Device. Oper Tech Thorac Cardiovasc Surg. https://doi.org/10.1053/j.optechstcvs.2023.04.005 Kappetein AP, Head SJ, Généreux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document (VARC-2)†. Eur J Cardiothorac Surg. 2012;42:S45–60. https://doi.org/10.1093/ejcts/ezs533 . Austin PC. 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P44: Veno-Arterial ECMO decannulation with percutaneous femoral arterial closure technique. ASAIO J. 2022;68:117. https://doi.org/10.1097/01.mat.0000841392.15070.e7 . Hwang Y, Kang CH, Kim H-S, et al. Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy on the patients with non-small cell lung cancer: a propensity score matching study. Eur J Cardiothorac Surg. 2015;48:273–8. https://doi.org/10.1093/ejcts/ezu422 . Bemtgen X, Heidt T, Zotzmann V, et al. Venoarterial extracorporeal membrane oxygenation decannulation using the novel Manta vascular closure device. Eur Heart J Acute Cardiovasc Care. 2020;9:342–7. https://doi.org/10.1177/2048872620918707 . Djavidi N, Boussouar S, Duceau B, et al. Vascular Complications After Venoarterial Extracorporeal Membrane Oxygenation Support: A CT Study. Crit Care Med. 2025;53:e96–108. https://doi.org/10.1097/CCM.0000000000006476 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 12 Apr, 2026 Read the published version in Critical Care → Version 1 posted Editorial decision: Revision requested 21 Feb, 2026 Reviews received at journal 12 Feb, 2026 Reviewers agreed at journal 11 Feb, 2026 Reviewers invited by journal 11 Feb, 2026 Editor assigned by journal 05 Feb, 2026 Submission checks completed at journal 05 Feb, 2026 First submitted to journal 28 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8722162","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":590379074,"identity":"e14e186f-15a5-442a-8552-d03a659f382c","order_by":0,"name":"Elodie Berg","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYDACdgYGiQQGBiBiYHzAwHCAgYH5AAEtzAgtzAZgLWwJRGhhgGhhkyBKCz8z88EbDyoY8vilj1+r+LnjTh4DG+8DvFokm9mSLRLOMBRL9uWU3ew986yYgY3dAK8Wg8M8ZhKJbQyJG87wpN3gbTuc2CDfht9h9mAt/xgS9wO1FP4FaWFjw6/FgBmkpQFoCw/7MWZeYrRIHAb55ZhEscQZHmZp2TOHi9kIaeFvbz5480eNTR5/D/vDj293HM7jJ6QFZhkQ8xgwMDYwJBCnAQLYH4C1kKBjFIyCUTAKRggAAJCHQzySwXqRAAAAAElFTkSuQmCC","orcid":"","institution":"Pitié-Salpêtrière Hospital","correspondingAuthor":true,"prefix":"","firstName":"Elodie","middleName":"","lastName":"Berg","suffix":""},{"id":590379075,"identity":"d809167c-595b-4be4-a258-9cf97c527dbb","order_by":1,"name":"Charles juvin","email":"","orcid":"","institution":"Pitié-Salpêtrière 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Rouen","correspondingAuthor":false,"prefix":"","firstName":"Nathalie","middleName":"","lastName":"Nardone","suffix":""},{"id":590379086,"identity":"58e8d4c7-dac1-4f7c-8acf-187df93c13ef","order_by":5,"name":"Pichoy Danial","email":"","orcid":"","institution":"Pitié-Salpêtrière Hospital","correspondingAuthor":false,"prefix":"","firstName":"Pichoy","middleName":"","lastName":"Danial","suffix":""},{"id":590379087,"identity":"44c0c03e-d65f-4255-aad1-74b99c9b422f","order_by":6,"name":"Cosimo D'Alessandro","email":"","orcid":"","institution":"Pitié-Salpêtrière Hospital","correspondingAuthor":false,"prefix":"","firstName":"Cosimo","middleName":"","lastName":"D'Alessandro","suffix":""},{"id":590379088,"identity":"e7dc9e1b-22e5-49f3-ac31-ebd657bf85ef","order_by":7,"name":"Aude Carillion","email":"","orcid":"","institution":"Pitié-Salpêtrière Hospital","correspondingAuthor":false,"prefix":"","firstName":"Aude","middleName":"","lastName":"Carillion","suffix":""},{"id":590379089,"identity":"445ec4de-ad91-47dd-953a-a297c0f17127","order_by":8,"name":"Alain Combes","email":"","orcid":"","institution":"Pitié-Salpêtrière Hospital","correspondingAuthor":false,"prefix":"","firstName":"Alain","middleName":"","lastName":"Combes","suffix":""},{"id":590379090,"identity":"da577fa3-3b4e-49d7-8519-2469412b203a","order_by":9,"name":"Pascal Leprince","email":"","orcid":"","institution":"Pitié-Salpêtrière Hospital","correspondingAuthor":false,"prefix":"","firstName":"Pascal","middleName":"","lastName":"Leprince","suffix":""},{"id":590379091,"identity":"ffe8cbc2-d067-49a3-bc92-0e3d47f79a15","order_by":10,"name":"Adrien Bougle","email":"","orcid":"","institution":"Pitié-Salpêtrière Hospital","correspondingAuthor":false,"prefix":"","firstName":"Adrien","middleName":"","lastName":"Bougle","suffix":""},{"id":590379092,"identity":"e4a0a3dd-78af-4165-ba81-a9f14c52f4c9","order_by":11,"name":"Guillaume Lebreton","email":"","orcid":"","institution":"Pitié-Salpêtrière Hospital","correspondingAuthor":false,"prefix":"","firstName":"Guillaume","middleName":"","lastName":"Lebreton","suffix":""}],"badges":[],"createdAt":"2026-01-28 14:39:55","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8722162/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8722162/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13054-026-06012-x","type":"published","date":"2026-04-12T15:58:59+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":106809526,"identity":"5a352dac-16d0-4263-8654-b00a2bf1b9a3","added_by":"auto","created_at":"2026-04-13 16:11:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1017499,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8722162/v1/c621e6bc-00ca-441f-94d9-6e49f78bb2ee.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Full percutaneous decannulation of VA-ECMO using MANTA® and Femoseal® devices: a propensity-score based study","fulltext":[{"header":"TAKE HOME MESSAGE","content":"\u003cp\u003eFull-percutaneous VA-ECMO decannulation reduced bleeding, transfusion, re-operation, and deep infection compared with manual compression, without affecting survival. Systematic imaging revealed frequent silent arterial lesions, highlighting the need for targeted surveillance and endovascular management.\u003c/p\u003e\n"},{"header":"Introduction","content":"\u003cp\u003eVeno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a life-saving therapy for refractory cardiogenic shock [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. While percutaneous cannulation reduces infectious complications compared with surgical access (16.5 vs. 27.8%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) with a better 30-day survival [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], However, arterial decannulation remains a critical step: manual compression, the current standard, carries a substantial risk of bleeding, vascular injury, and infection, often requiring surgical revision. These complications may offset the benefits of percutaneous cannulation [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo address these limitations, we developed a fully percutaneous decannulation technique (FP-D) combining the MANTA\u0026reg; vascular closure device for the arterial cannula and Femoseal\u0026reg; for the reperfusion cannula [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. We hypothesized that FP-D would reduce bleeding and infectious complications compared with manual compression, without impairing short-term survival.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and population\u003c/h2\u003e \u003cp\u003eWe conducted a single-center retrospective study at Piti\u0026eacute;-Salp\u0026ecirc;tri\u0026egrave;re Hospital (Paris, France). All patients supported with percutaneous femoro-femoral VA-ECMO between October 2020 and May 2022 and decannulated using the fully percutaneous decannulation (FP-D) technique were included. FP-D patients were compared with a historical cohort decannulated using manual compression (MC), before FP-D implementation. Demographic, perioperative, and outcome data were collected from electronic medical records and institutional registries. The database was approved by the French National Data Protection Authority (CNIL, reference 4Lj17203757). The study was approved by the Ethics Comitee of the French Society of thoracic and cardiovascular surgery (SFCTCV, IRB00012919). The study complied with the Declaration of Helsinki; informed consent was waived according to French law.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDecannulation techniques\u003c/h3\u003e\n\u003cp\u003eFP-D consisted of closure of the arterial cannula with the MANTA\u0026reg; device and the reperfusion cannula with Femoseal\u0026reg;., as previously described by our team [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In the MC group, decannulation was achieved by manual compression at the cannulation site. FP-D failure was defined as the need for secondary manual compression and/or surgical revision.\u003c/p\u003e\n\u003ch3\u003eOutcomes\u003c/h3\u003e\n\u003cp\u003eThe primary outcome was surgical revision after decannulation.\u003c/p\u003e \u003cp\u003eSecondary outcomes included FP-D failure\u0026mdash;defined as the need for manual compression and/or surgical revision following decannulation\u0026mdash;and vascular complications. These complications comprised severe bleeding (defined as bleeding associated with a drop in hemoglobin\u0026thinsp;\u0026ge;\u0026thinsp;3.0 g/dL, or requiring transfusion of \u0026ge;\u0026thinsp;2\u0026ndash;3 units of whole blood or red blood cells, or resulting in hospitalization, permanent injury, or surgery without meeting the criteria for life-threatening or disabling bleeding, as defined by the VARC-2 consensus [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]), cannulation site infections, arterial dissections and thrombosis. Asymptomatic vascular complications related to cannulation (i.e., incidental findings) were assessed through review of follow-up CT scans, including dissection lesions extending to the external iliac arteries. Additional recorded outcomes included neurological complications, compartment syndrome requiring fasciotomy, and limb amputations.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eContinuous variables are expressed as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations or medians (interquartile range) and were compared with Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e test or Wilcoxon rank sum test, as appropriate. Categorical variables are expressed as percentages and were compared using chi-squared\u003c/p\u003e \u003cp\u003etests.\u003c/p\u003e \u003cp\u003eClinical endpoints were compared between MANTA\u0026reg; and compression groups using propensity score (PS) framework. Patients for whom ECMO removal was performed as part of end-of-life care in the context of terminal cardiac disease were excluded from the propensity score analysis The PS approach aims at creating a new dataset in which the probability to MANTA\u0026reg; or compression weaning ECMO is equal (as in a pure randomized trial) to balance patients\u0026rsquo; baseline characteristics.\u003c/p\u003e \u003cp\u003eMANTA\u0026reg; and compression group patients were compared using PS weighting. The propensity score, representing the probability of a patient receiving the MANTA\u0026reg; device given their baseline characteristics, was estimated using logistic regression. Variables included in the propensity score model were: age, sex, BMI, smoking, hypercholesterolemia, arterial hypertension, and indication of VA ECMO. To estimate the causal treatment effect, we utilized overlap weights. This method weights each patient by the inverse probability of their actual treatment weighted by the probability of receiving the opposite treatment, which estimates the average treatment effect in the population with maximum overlap in propensity scores. Covariate balance between the two groups was assessed after weighting, and we considered an absolute standardized difference less than 0.1 as evidence of adequate balance[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Then, clinical endpoints were compared between MANTA\u0026reg; and compression groups within the weighted dataset. Overlap weighting assigns weights proportional to the probability of receiving the opposite treatment. Individuals who receive the actual treatment are weight by 1 minus their PS, and those who received the opposite treatment are weighted by their PS [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Overall survival until day 30 was estimated in the two groups by the Kaplan\u0026ndash;Meier method in the weighted sample.\u003c/p\u003e \u003cp\u003eA \u003cem\u003ep\u003c/em\u003e value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. Statistical analyzes were conducted with R v3.5.1.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eFP-D group results\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003eAmong the 263 patients weaned from VA-ECMO using the FP-D technique, 20 (7.6%) experienced procedural failure requiring secondary manual compression. Obesity (median BMI 29 vs 25, p\u0026thinsp;=\u0026thinsp;0.0071) and diabetes (40% vs 15.6%, p\u0026thinsp;=\u0026thinsp;0.0116) were significantly associated with FP-D failure (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of the FP-D group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eFP-D group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eOverall 263 (100%)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eFailure 20 (7.60%)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eSucess 243 (92.40%)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003epValue\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003cp\u003eMedian [Q1, Q3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 [38, 63]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57[44, 63.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52 [38, 63]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.4884\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (28.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (25.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69 (28.40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.7455\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBMI, Kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMedian [Q1, Q3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.4 [22.55, 29.07]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.01 [24.59, 34.14]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.15 [22.49, 28.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.0071\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109 (41.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e97 (39.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0797\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHypercholesterolemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (18.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7 (35.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42 (17.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0691\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (17.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38 (15.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.0116\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eArterial hypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (29.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9 (45.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69 (28.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.1181\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePeripheral artery disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.1711\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCreatinine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.2177\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian [Q1, Q3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e113 [78.00, 169.00]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e128 [99.00, 157.00]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e110 [72, 172]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTherapy plan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBridge to recovery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e245 (93.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (95.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e226 (93.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBridge to intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (5.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResuscitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eEtiology of Cardiac Shock\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost cardiotomy CS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51 (19.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (15.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48 (19.75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary graft failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38 (14.45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (25.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33 (13.58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMI-related CS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58 (22.05%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (35.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51 (20.99%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDilated cardiopathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (7.60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (5.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 (7.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMyocarditis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (12.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (5.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33 (13.58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHeart-Kidney transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (2.28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (5.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (2.06%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost partum cardiopathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (3.04%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (5.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (2.88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48 (18.25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (5.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47 (19.34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eClinical outcomes after decannulation are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Arterial cannula diameter was not associated with failure (p\u0026thinsp;=\u0026thinsp;0.17). The mean duration of ECMO support was 8 days (maximum 47 days), and did not differ significantly between patients with successful decannulation and those with failure (8.3 vs 11.7 days, p\u0026thinsp;=\u0026thinsp;0.075). FP-D failure was strongly associated with major bleeding (35% vs 0.4%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) and with transfusion (31.6% vs 0.9%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). MANTA failure was significantly associated with surgical reoperation (50% vs 4.7%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). In cases of MANTA failure, subsequent interventions were mostly performed using an open surgical approach (60%), whereas secondary MANTA-related complications were predominantly managed percutaneously (63.6%). The mean follow-up was 204 days. Two early deaths, likely due to hemorrhagic shock, occurred shortly after decannulation; both events arose early in the learning curve.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical outcomes in the FP-D group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eMANTA\u0026reg;\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eOverall n\u0026thinsp;=\u0026thinsp;263 (100%)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eFailure, n\u0026thinsp;=\u0026thinsp;20 (7.60%)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eSuccess, n\u0026thinsp;=\u0026thinsp;243 (92.40%)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003ep value\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eArterial cannula size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17Fr 23 cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e188 (71.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (70.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e174 (71.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15Fr 23cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (5.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19Fr 23cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (19.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50 (20.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (15.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11 (4.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eECMO Duration, days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.3 (6.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.7 (6.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.02 (6.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLimb Acute ischemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (2.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (1.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0507\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMajor Bleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (3.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (35.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eInfection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (15.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (6.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.138\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLymphorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePeripheral neurological complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSurgical revision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (8.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (4.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eType of surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.3949\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOpen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (47.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4 (36.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEndovascular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (52.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7 (63.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFP-D related transfusion*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (3.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (31.58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (0.94%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSubclinical arterial complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (37.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (46.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61 (36.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.4474\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eArterial complication secondary to cannulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (22.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29 (21.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.7073\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eEvolution of arterial injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLesion improvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (33.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11 (34.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRecovery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (15.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5 (15.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePersistence of injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (51.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll cause\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81 (30.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (30.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e75(30.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDeath procedure-related\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(1.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1(41.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003e*Transfusion required by FP-D complication (excluding transfusion related to other indications)\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eCT-Scan follow-up\u003c/h3\u003e\n\u003cp\u003eAmong the 180 patients (69%) who underwent systematic CT scanning after decannulation, 68 (38%) had asymptomatic arterial injuries. Vascular lesions related to intra-aortic balloon pump (IABP) use or arterial catheterization were identified in 12 patients (6.6%). One patient developed a false aneurysm of the superficial femoral artery, attributed to reperfusion cannula removal. Extensive external iliac artery lesions were present in 30 patients (16.6%). Incomplete thromboses with collateralization were observed in 17 patients (9.4%), while 13 patients had dissections extending to the common iliac artery but not involving the abdominal aorta. Focal lesions were detected in 26 patients (14.4%), including 11 cases (6.1%) attributed to cannulation too close to the femoral bifurcation. Four femoral stenoses (2.2%) were \u0026lt;\u0026thinsp;50% in severity, and the remaining 11 lesions (6.6%) were primarily focal dissections with associated thrombosis.\u003c/p\u003e \u003cp\u003eImmediately after decannulation, 6 patients (3.3%) required surgical intervention, including 4 endovascular procedures. One additional patient underwent endovascular treatment after discharge from the intensive care unit.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFP-D group vs MC group\u003c/h2\u003e \u003cp\u003eBetween October 2020 and May 2022, 497 patients underwent percutaneous femoro-femoral VA-ECMO for refractory cardiogenic shock: 250 in the FP-D group and 247 in the MC group (propensity score, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Patients with surgical cannulation were excluded.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient Characteristics of the entire study cohort and after propensity-score analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBefore PS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eAfter PS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMC group n\u0026thinsp;=\u0026thinsp;247 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFP-D group n\u0026thinsp;=\u0026thinsp;250 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMC group,\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;247\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFP-D group, n\u0026thinsp;=\u0026thinsp;250\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge,years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 [43 ; 64]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.5 [38 ; 63]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0889\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e52.667 (\u0026plusmn;\u0026thinsp;14.965)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e52.667 (\u0026plusmn;\u0026thinsp;15.036)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (32.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.2332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e28.3 (\u0026plusmn;\u0026thinsp;0.451)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e28.3 (\u0026plusmn;\u0026thinsp;0.451)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.3 [22.85 ; 29.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.35 [22.72 ; 29.1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.9269\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e26.297 (\u0026plusmn;\u0026thinsp;6.422)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e26.297 (\u0026plusmn;\u0026thinsp;5.011)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtherosclerosis factor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96 (38.87%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103 (41.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.6211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e42,7 (\u0026plusmn;\u0026thinsp;0.496)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e42,7 (\u0026plusmn;\u0026thinsp;0.496)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArterial hypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e135 (54.66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (29.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e40.5 (\u0026plusmn;\u0026thinsp;0.492)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e40.5 (\u0026plusmn;\u0026thinsp;0.492)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyslipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82 (33.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (18.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e26.6 (\u0026plusmn;\u0026thinsp;0.443)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e26.6 (\u0026plusmn;\u0026thinsp;0.443)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes Mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (21.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.1137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e19.4 (\u0026plusmn;\u0026thinsp;0.396)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e19.4 (\u0026plusmn;\u0026thinsp;0.396)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEtiology of Cardiac Shock\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.4935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost cardiotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (17.81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e19.5 (\u0026plusmn;\u0026thinsp;0.397)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e19.5 (\u0026plusmn;\u0026thinsp;0.397)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary graft failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (27.13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (15.20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e19.7 (\u0026plusmn;\u0026thinsp;0.399)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e19.7 (\u0026plusmn;\u0026thinsp;0.399)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMI-related CS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (18.22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (21.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e22.3 (\u0026plusmn;\u0026thinsp;0.417)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e22.3 (\u0026plusmn;\u0026thinsp;0.417)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDilated cardiopathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (17.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (7.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e10.3 (\u0026plusmn;\u0026thinsp;0.305)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e10.3 (\u0026plusmn;\u0026thinsp;0.305)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMyocarditis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (3.24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (12.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e6.2 (\u0026plusmn;\u0026thinsp;0.242)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e6.2 (\u0026plusmn;\u0026thinsp;0.242)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (16.19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (23.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e22 (\u0026plusmn;\u0026thinsp;0.415)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e22 (\u0026plusmn;\u0026thinsp;0.415)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe main indications for short-term support were primary graft failure (27.13% in MC vs 15.2% in FP-D), acute myocardial infarction\u0026ndash;related cardiogenic shock (18.22% vs 21.2%), and post-cardiotomy shock (17.81% vs 20.0%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePrimary and secondary endpoints\u003c/h2\u003e \u003cp\u003ePost-decannulation events are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The rate of revision surgery (all causes) was significantly lower in the FP-D group compared with MC (3.9% vs 7.2%; RR 0.55, 95% CI 0.32\u0026ndash;0.95; p\u0026thinsp;=\u0026thinsp;0.0311). Infections requiring surgery (3.7% vs 8.4%; RR 0.44, 95% CI 0.25\u0026ndash;0.77; p\u0026thinsp;=\u0026thinsp;0.004), major bleeding (1.4% vs 11%; RR 0.13, 95% CI 0.06\u0026ndash;0.30; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), and transfusion requirements (7.2% vs 45.7%; RR 0.16, 95% CI 0.11\u0026ndash;0.22; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) were also significantly lower in the FP-D group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Acute limb ischemia tended to be less frequent with FP-D (1.2% vs 3.2%), although the difference was not statistically significant (RR 0.39, 95% CI 0.14\u0026ndash;1.10; p\u0026thinsp;=\u0026thinsp;0.0749).\u003c/p\u003e \u003cp\u003e \u003cem\u003e30-day Survival\u003c/em\u003e \u003c/p\u003e \u003cp\u003eUnadjusted 30-day survival was 84.8% in the FP-D group and 88.7% in the MC group (p\u0026thinsp;=\u0026thinsp;0.20). After propensity score, survival remained similar (91.8% vs 94.5%; RR 1.49, 95% CI 0.89\u0026ndash;2.50; p\u0026thinsp;=\u0026thinsp;0.1316; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVA-ECMO-related outcomes in the propensity score population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMC Group (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFP-D group (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransfusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.16 [0.11 ; 0.22]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMajor bleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.13[0.06 ; 0.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.44 [0.25 ; 0.77]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute Limb Ischemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.39 [0.14 ; 1.1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0749\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esurgical revision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.55 [0.32 ; 0.95]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.0311\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30-day Survival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.49 [0.89\u0026nbsp;;2.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1316\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this large propensity score cohort, full percutaneous decannulation (FP-D) of femoro-femoral VA-ECMO using MANTA\u0026reg; and Femoseal\u0026reg; was associated with significantly fewer hemorrhagic and infectious complications compared with manual compression, while short-term survival remained comparable. FP-D failures were infrequent (7.6%) and mainly associated with obesity and diabetes. Importantly, systematic post-decannulation CT imaging revealed a high prevalence of asymptomatic arterial lesions, some requiring endovascular management.\u003c/p\u003e \u003cp\u003eOur results are consistent with and extend prior reports on percutaneous ECMO decannulation. Proglide\u0026reg;-based strategies have been described with promising results in terms of limb ischemia reduction [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], but their applicability is limited in unstable patients requiring urgent cannulation, as pre-closure is often unfeasible. Moreover, prolonged device dwelling may increase infection risk [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In contrast, the FP-D technique using MANTA\u0026reg; provides immediate hemostasis at the time of decannulation without the need for pre-placement, which is particularly advantageous in ECMO runs of several days. Previous series of MANTA\u0026reg; for ECMO decannulation were small and lacked systematic imaging, limiting their ability to assess vascular sequelae [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. By including over 250 patients and incorporating CT follow-up, our study adds robust evidence that FP-D reduces major morbidity without compromising survival.\u003c/p\u003e \u003cp\u003eMoreover, the technique previously described [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] relies on ultrasound and the Pythagorean theorem to estimate the distance between the skin and the artery. However, such measurements are often unreliable because edema distorts the tissues and affects the calculation.\u003c/p\u003e \u003cp\u003eOne of the most striking findings of our study is the high incidence of subclinical arterial lesions identified by CT angiography. Although many dissections and non-occlusive thromboses remained clinically silent, several required endovascular repair, and the long-term significance of these lesions remains uncertain. Previous work from our group and others has suggested that up to 30% of ECMO patients may develop femoral artery thrombosis, often without symptoms [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Our results support systematic vascular imaging after decannulation to guide follow-up and early intervention when indicated. Such an approach could prevent late complications such as claudication, aneurysm formation, or chronic ischemia.\u003c/p\u003e \u003cp\u003eThe success of FP-D is highly dependent on optimal cannulation technique. Puncture too close to the femoral bifurcation increases the risk of focal stenosis or thrombosis, as observed in our series [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Ultrasound-guided puncture at an adequate distance from the bifurcation is therefore essential. FP-D also requires precise measurement of puncture depth, which can be challenging in the presence of edema [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Although two early fatal bleeding events occurred, they were clustered at the beginning of our experience, suggesting a learning curve effect. With growing familiarity, FP-D proved reproducible and safe in the majority of cases.\u003c/p\u003e \u003cp\u003eSeveral limitations should be acknowledged. First, this was a single-center study in a high-volume ECMO program, which may limit external validity. Both complication and mortality data were prospectively collected, but some baseline and cannulation-related variables were retrospectively retrieved. Second, CT follow-up was incomplete (69%), potentially leading to underestimation of subclinical vascular lesions. Third, long-term outcomes of these lesions remain unknown. Finally, the use of MANTA\u0026reg; in this context is off-label [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], although our results support its feasibility and safety.\u003c/p\u003e \u003cp\u003eDespite these limitations, our findings suggest that FP-D is a safe and effective alternative to manual compression, significantly reducing decannulation-related morbidity. By minimizing bleeding, transfusion, and infection, FP-D may contribute to improved outcomes in this fragile population. Moreover, systematic imaging after decannulation appears crucial to detect clinically silent but potentially significant arterial lesions. Future multicenter studies should confirm these results, assess cost-effectiveness, and determine whether vascular imaging surveillance should be incorporated into standard ECMO protocols.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFull percutaneous decannulation of VA-ECMO using MANTA\u0026reg; and Femoseal\u0026reg; significantly reduced bleeding, transfusion, infection, and surgical revision compared with manual compression, while preserving survival. The technique proved safe and reproducible, with a low failure rate. Systematic CT imaging revealed frequent but often silent arterial lesions, underscoring the importance of structured vascular surveillance and, when appropriate, endovascular management.\u003c/p\u003e \u003cp\u003eThese findings support FP-D as a valuable alternative to manual compression in high-volume ECMO programs. Future multicenter studies should confirm its generalizability and clarify the long-term impact of subclinical vascular lesions.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e Ethical Approval and Consent to participate\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethics Comitee of the French Society of thoracic and cardiovascular surgery (SFCTCV, IRB00012919). The study complied with the Declaration of Helsinki; informed consent was waived according to French law.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Consent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eAvailability of supporting data\u003c/p\u003e\n\u003cp\u003eNo funding sources.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eAuthors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003ePr Lebreton designed the study and performed critical revisions of the manuscript.\u003c/p\u003e\n\u003cp\u003eDr Berg designed the tables and figures and wrote the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors gave critical comments on the manuscript and approved it for submission.\u003c/p\u003e\n\u003cp\u003eAll co-authors reviewed the manuscript\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors wish to thank Pr Hajage for statistical analysis.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCombes A, Brodie D, Chen Y-S, et al. 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Venoarterial extracorporeal membrane oxygenation decannulation using the novel Manta vascular closure device. Eur Heart J Acute Cardiovasc Care. 2020;9:342\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/2048872620918707\u003c/span\u003e\u003cspan address=\"10.1177/2048872620918707\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDjavidi N, Boussouar S, Duceau B, et al. Vascular Complications After Venoarterial Extracorporeal Membrane Oxygenation Support: A CT Study. Crit Care Med. 2025;53:e96\u0026ndash;108. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/CCM.0000000000006476\u003c/span\u003e\u003cspan address=\"10.1097/CCM.0000000000006476\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"critical-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cric","sideBox":"Learn more about [Critical Care](http://ccforum.biomedcentral.com/)","snPcode":"13054","submissionUrl":"https://submission.nature.com/new-submission/13054/3","title":"Critical Care","twitterHandle":"@Crit_Care","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Extracorporeal Membrane Oxygenation, Decannulation, Vascular Closure Devices, Hemostasis, Complications","lastPublishedDoi":"10.21203/rs.3.rs-8722162/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8722162/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePercutaneous veno-arterial extracorporeal membrane oxygenation (VA-ECMO) implantation reduces infectious complications compared with surgical cannulation. However, arterial decannulation using manual compression remains associated with bleeding, vascular injury, and infection. We evaluated a fully percutaneous decannulation strategy (FP-D) combining MANTA\u0026reg; and Femoseal\u0026reg; devices.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAll patients undergoing FP-D between October 2020 and May 2022 in our institution were included. Outcomes were compared with a historical cohort decannulated using manual compression (MC). The primary endpoint was surgical revision after decannulation. Secondary endpoints included major bleeding, transfusion, vascular complications, infection, and 30-day survival. A propensity score weighting approach was performed to adjust for baseline differences.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 497 patients treated with percutaneous VA-ECMO, 250 underwent FP-D and 247 MC. After propensity score, FP-D significantly reduced surgical revision (3.9% vs 7.2%; RR 0.55, 95% CI 0.32\u0026ndash;0.94; p\u0026thinsp;=\u0026thinsp;0.0311), infection requiring surgery (3.7% vs 8.4%; RR 0.44, 95% CI 0.25\u0026ndash;0.77; p\u0026thinsp;=\u0026thinsp;0.004), and major bleeding (1.4% vs 11%; RR 0.13, 95% CI 0.06\u0026ndash;0.30; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), with lower transfusion requirements (7.1% vs 45.7%; RR 0.16, 95% CI 0.11\u0026ndash;0.22; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Thirty-day survival was comparable between groups (91.8% vs 94.7%; p\u0026thinsp;=\u0026thinsp;0.11). Systematic CT scans revealed frequent but mostly silent arterial lesions after FP-D.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eFP-D markedly reduced bleeding, transfusion, infection, and surgical revision compared with manual compression, while preserving short-term survival. Systematic imaging identified frequent subclinical vascular lesions, supporting targeted surveillance and endovascular management when appropriate.\u003c/p\u003e","manuscriptTitle":"Full percutaneous decannulation of VA-ECMO using MANTA® and Femoseal® devices: a propensity-score based study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-16 08:30:57","doi":"10.21203/rs.3.rs-8722162/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-21T19:14:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-12T15:24:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"165583590811459900300258523890304122118","date":"2026-02-11T13:39:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-11T11:08:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-05T23:18:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-05T23:18:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"Critical Care","date":"2026-01-28T13:16:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"critical-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cric","sideBox":"Learn more about [Critical Care](http://ccforum.biomedcentral.com/)","snPcode":"13054","submissionUrl":"https://submission.nature.com/new-submission/13054/3","title":"Critical Care","twitterHandle":"@Crit_Care","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"aaf4c927-48c7-4c2d-8aab-70117d53103d","owner":[],"postedDate":"February 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-13T16:07:35+00:00","versionOfRecord":{"articleIdentity":"rs-8722162","link":"https://doi.org/10.1186/s13054-026-06012-x","journal":{"identity":"critical-care","isVorOnly":false,"title":"Critical Care"},"publishedOn":"2026-04-12 15:58:59","publishedOnDateReadable":"April 12th, 2026"},"versionCreatedAt":"2026-02-16 08:30:57","video":"","vorDoi":"10.1186/s13054-026-06012-x","vorDoiUrl":"https://doi.org/10.1186/s13054-026-06012-x","workflowStages":[]},"version":"v1","identity":"rs-8722162","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8722162","identity":"rs-8722162","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}