{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T05:32:09Z","timestamp":1793856729491,"version":"4.6.1"},"reference-count":28,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T00:00:00Z","timestamp":1695081600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"iPerf SAS"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Peripheral femoro-femoral veno-arterial extracorporeal membrane oxygenation is increasingly used in refractory cardiogenic shock. However, the obstruction of the femoral artery by the return cannula could lead to acute limb ischemia, a frequently encountered situation that is inconstantly prevented by the adjunction of a distal perfusion cannula (DPC). The aim of this study was to investigate the influence of three physical parameters on the perfusion of the cannulated lower limb. Methods: Using patient-specific arterial models and computational fluid dynamic simulations, we studied four diameters of arterial cannula, three diameters of DPC, and two percentages of arterial section limitation. Results: We found that adequate perfusion of the cannulated limb was achieved in only two out of the twenty-one configurations tested, specifically, when the arterial cannula had a diameter of 17 Fr, was considered to limit the section of the artery by 90%, and was associated with an 8 Fr or a 10 Fr DPC. Multivariable analysis revealed that the perfusion of the cannulated lower limb was correlated with the diameter of the DPC, but also with the diameter of the arterial cannula and the percentage of arterial section limitation. Conclusions: In most of the cases simulated here, the current system combining unsized arterial cannula and non-specific DPC was not sufficient to provide adequate perfusion of the cannulated lower limb, urging the need for innovative strategies to efficiently prevent acute limb ischemia during peripheral femoro-femoral veno-arterial extracorporeal membrane oxygenation.<\/jats:p>","DOI":"10.3390\/jcm12186049","type":"journal-article","created":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T23:17:20Z","timestamp":1695165440000},"page":"6049","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Preventing Acute Limb Ischemia during VA-ECMO\u2014In Silico Analysis of Physical Parameters Associated with Lower Limb Perfusion"],"prefix":"10.3390","volume":"12","author":[{"given":"Tifanie","family":"Brockaert","sequence":"first","affiliation":[{"name":"Universit\u00e9 de Technologie de Compi\u00e8gne, 60200 Compi\u00e8gne, France"},{"name":"Iperf, 1 Avenue de Champfleury, 69410 Champagne-au-Mont-d\u2019Or, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In\u00eas","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Iperf, 1 Avenue de Champfleury, 69410 Champagne-au-Mont-d\u2019Or, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Laplante","sequence":"additional","affiliation":[{"name":"Iperf, 1 Avenue de Champfleury, 69410 Champagne-au-Mont-d\u2019Or, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5398-6622","authenticated-orcid":false,"given":"Paul","family":"Fogel","sequence":"additional","affiliation":[{"name":"Mazars, Tour Exaltis 61 rue Henri Regnault, 92400 Courbevoie, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Grimbert","sequence":"additional","affiliation":[{"name":"Mazars, Tour Exaltis 61 rue Henri Regnault, 92400 Courbevoie, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Mordant","sequence":"additional","affiliation":[{"name":"Service de Chirurgie Vasculaire, Thoracique, et Transplantation Pulmonaire, H\u00f4pital Bichat, Universit\u00e9 Paris\u2014Cit\u00e9, Assistance Publique\u2014H\u00f4pitaux de Paris, 75018 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1051\/ject\/201850155","article-title":"Distal Perfusion Cannulation and Limb Complications in Venoarterial Extracorporeal Membrane Oxygenation","volume":"50","author":"Elmously","year":"2018","journal-title":"J. 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