Iliac Vessel Cannulation for Pediatric Cardiac Surgery

This video demonstrates the steps of iliac vessel cannulation that the authors use for redo pediatric cardiac surgery. The draping gives provides access to bilateral Iliac vessels and to the sternum. First, the incision is planned after palpating the femoral pulses. Then the skin is incised above and parallel to the right inguinal ligament. The subcutaneous tissue is dissected, and the oblique muscle is reflected away. The position is confirmed by feeling the pulse. Next, the lower edge of the incision is pulled away and fixed to the drapes with silk sutures to avoid the need for self-retaining retractors and the cannulae bending over these retractors. The vein is then looped with free silk and snuggers for proximal and distal control of the vessel. After this, the branch is looped with a finer silk thread. Similarly, proximal and distal control of the artery is taken with silk sutures and snuggers. Following this, the branch is looped and blocked prior to the cannulation. 

Cannulation 

The proximal and distal vascular clamps are placed on the artery, and it is opened transversely. The incision is then enlarged and dilated. Next, the arterial cannula is inserted without the stylet by controlling the proximal clamp. The proximal snugger is snugged over the cannula, and the cannula is deaired and connected. Then it is fixed to the drape with a silk suture. Similarly, the vein is cannulated after applying the clamp and opening transversely. The proximal snugger is snugged and the cannula is deaired and connected. 

Decannulation 

After coming off cardiopulmonary bypass, the arterial is first removed and then followed by the removal of the venous canulae using the proximal snugger for control. Then the clamps are reapplied proximally and distally. After this, the incision is closed with 7-0 polypropylene sutures in a continuous fashion starting from the opposite ends and tied in the middle, first for the artery and then for the vein. Finally, the incision is closed with interrupted sutures. 

References

Sfyridis PG, Mylonas KS, Kalangos A. Abdominal Vessel Cannulation Before Resternotomy in Complex Congenital Heart Surgery. Ann Thorac Surg. 2020 Mar;109(3):e219-e221. doi: 10.1016/j.athoracsur.2019.08.097. PMID: 31589855.

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