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.