Miami Minimally Invasive Valves
Joseph Lamelas, MD
Dedicated to the Advancement of Minimally Invasive Cardiac Surgery
June 16, 2012
Femoral Cannulation

I have been using a femoral platform as my cannulation strategy of choice for the last 8 years. I have utilized this access in over 2,000 patients.   I don’t order a routine pre-op CT angiogram.  I pay close attention to the amount of calcification present in the artery after exposure.  If there is only a posterior plaque, I proceed.  I pass the guidewire into the artery towards the distal arch.  If I don’t meet any resistance I will proceed with the femoral cannulation.  The cannula should also be advanced with ease.  If one feels resistance or an obstruction, then this access point needs to be abandoned.  If one passes the cannula and feels a gritty sensation (cannula riding over plaque), this is really not a issue unless the cannula cannot be advanced. The cannula needs to be advanced completely into the artery.

I have gone to using the Medtronic BioMedicus cannula due to excellent flow characteristics and less resistance compared to others.

BSA up to 1.6 — 15 Fr. Cannula (yes, 15!)

BSA 1.7 – 2.1  — 17Fr. Cannula

BSA 2.2 and greater — 19fr. Cannula

I ALWAYS use a 25 Fr. venous cannula

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2 thoughts on “Femoral Cannulation”

  1. Alaa Nady says:

    is previous femoral catheterization is a contraindication of femoral cannulation ?
    because in the last case i performed femoral cannulation , i was confronted with a big femoral AV fistula , ( mostly post-cath ) and it made cannulation problematic.

    1. Previous femoral catheterizaton is not a contraindication, although there will be more scarring and hematoma that one may encounter. That is why I prefer to cannulate on the left. I prefer right sided cannulation in obese females in whom I am performing a mini MVR. These patients are positioned with the right side elevated and the pannus usually shifts to the left, obscuring visibility of the left groin. I am surprised that the AV fistula was not picked up earlier by the cardiologist, but I guess it can happen. This is a rare finding and unfortunately you had to confront it. Don’t let this discourage you.

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