title: A novel percutaneous solution to limb ischemia due to arterial occlusion from a femoral artery ECMO cannula.
abstract: OBJECTIVE
  To describe a novel percutaneous technique for distal limb perfusion in the face of femoral artery occlusion secondary to extracorporeal membrane oxygenation (ECMO) cannula placement.
  
  
  METHODS
  The technique is described in a 59-year-old man who presented with an inferior wall myocardial infarction and a large ventricular septal defect (VSD) requiring the initiation of ECMO via right femoral artery and vein cannulae. He subsequently developed right lower limb ischemia secondary to cannula occlusion of the femoral artery. Percutaneous transfemoral placement of a flush catheter in the right common femoral artery was performed angiographically. Ischemic symptoms resolved, and the patient was subsequently able to undergo repair of his VSD without any further lower limb ischemic sequelae.
  
  
  CONCLUSIONS
  Percutaneous transfemoral placement of a flush catheter in the common femoral artery distal to ECMO cannula insertion has not to our knowledge been reported and carries the added benefit of restoring perfusion to both superficial and profunda femoris arteries.
authors.affiliation: Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Atul S
authors.initials: AS
authors.lastname: Rao
authors.forename: Ronald V
authors.initials: RV
authors.lastname: Pellegrini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Speziali
authors.forename: Luke K
authors.initials: LK
authors.lastname: Marone
mesh_terms: D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000295:instrumentation*; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000601:surgery*; D006801:Humans; D056989:Inferior Wall Myocardial Infarction / Q000150:complications / Q000628:therapy*; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012039:Regional Blood Flow; D016896:Treatment Outcome