Surgical Decannulation Using the Purse-String Technique in Venoarterial Extracorporeal Membrane Oxygenation Patients

Background: Surgical femoral arterial decannulation following venoarterial extracorporeal membrane oxygenation (V-A ECMO) can lead to serious vascular complications. Among surgical options, the purse-string method has gained attention as a potentially simpler and less invasive alternative. However, clinical data evaluating its safety and feasibility remain limited. Methods: We retrospectively analyzed 325 adult patients who underwent femoral arterial decannulation following V-A ECMO support from 2012 to 2023 at a single tertiary center. Of these, 87 patients received decannulation using the purse-string technique. Propensity score matching was used to contextualize outcomes relative to the conventional cross-clamp method. Results: The purse-string technique significantly reduced operative time (132.9 ± 88.5 vs. 74.1 ± 36.9 min; p < 0.001) without increasing reintervention rates. Most reinterventions in the purse-string group were detected by early imaging surveillance, while cross-clamp patients more frequently presented with symptomatic complications such as acute ischemia. Vessel injuries and late vascular complications occurred exclusively in the cross-clamp group. No patient in the purse-string cohort experienced permanent limb loss or amputation. Conclusion: The purse-string technique enables efficient and safe decannulation after V-A ECMO, offering a less invasive alternative to cross-clamp repair. This less invasive method may be particularly advantageous in critically ill patients or bedside settings where minimizing operative time and vascular trauma is essential.