Objectives: 

Decannulation after pediatric extracorporeal life support (ECLS) may be accompanied by arterial reconstruction. There is a paucity of data on arterial morphology following reconstruction. We sought to characterize morphology of reconstructed arteries to better understand long-term risk of arterial narrowing and blood flow alteration.

Design: 

Retrospective, single-institution review, 2002–2022.

Setting: 

Free-standing, 420-bed quaternary care children’s hospital in the U.S. Pacific Northwest.

Patients: 

We identified children of any age who were decannulated from ECLS with arterial reconstruction, using a 20-year registry. We excluded patients who did not survive.

Interventions: 

None.

Measurements and Main Results: 

We collected patient demographics data, indications for ECLS, reconstruction strategies, surgeon specialty, and any available post-decannulation imaging results. Associations between variables and morphologic changes were assessed on univariate analysis and then combined into a forward stepwise multivariable regression model (using p = 0.20 as a threshold). Among surviving patients, 144 underwent carotid artery reconstruction and 25 femoral, with 59 of 144 (41.0%) and 23 of 25, respectively, undergoing post-reconstruction imaging. Follow-up imaging was performed at a median of 21 and 9 days, respectively. On follow-up, 25 of 59 patients (42%) undergoing carotid reconstruction and eight of 23 patients undergoing femoral reconstruction had occlusion or other morphologic changes on imaging. Neonatal age at reconstruction was a significant risk factor for these changes.

Conclusions: 

A considerable proportion of patients undergoing arterial reconstruction after decannulation from ECLS develop vessel occlusion or other morphologic changes in short-term follow-up. Longer-term imaging is critical to aid risk stratification as ECLS survivors enter adulthood with attendant risks for atherosclerotic vascular disease.