{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T06:01:43Z","timestamp":1785391303982,"version":"3.55.0"},"reference-count":12,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>\n                    Critical limb ischemia (CLI) secondary to femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a recognized and morbid complication, with an incidence reaching 25.4% when prophylactic distal perfusion catheter (DPC) placement is omitted at cannulation. We report the case of a 77-year-old male [height 170\u2005cm, weight 62\u2005kg, body surface area (BSA) 1.72\u2005m\n                    <jats:sup>2<\/jats:sup>\n                    ] with long QT syndrome (LQTS), dilated cardiomyopathy, and a recent mitral valve replacement who developed refractory cardiogenic shock and electrical storm in the postoperative period, requiring VA-ECMO support via femoro-femoral cannulation. Progressive CLI of the right lower limb was confirmed by duplex Doppler ultrasound on day 8 of extracorporeal support, demonstrating occlusive thrombosis at the popliteal level with near-absent infrapopliteal flow. The limb was classified as Society for Vascular Surgery (SVS) Class IIb (immediately threatened). Emergency surgical intervention included Fogarty thrombectomy and femoro-popliteal bypass with a 6\u2005mm ringed Propaten graft. The novel technical element was the direct coupling of the VA-ECMO arterial perfusion cannula to the prosthetic anastomosis via a three-way Luer-lock stopcock, providing dual-source distal perfusion without requiring an independent perfusion catheter. Immediate limb perfusion was restored and confirmed intraoperatively. The patient subsequently died from refractory cardiogenic shock attributed to irreversible cardiac failure, precluding assessment of durable functional limb outcome. This case documents an innovative surgical strategy for refractory VA-ECMO-related CLI that may serve as a technical reference when standard distal perfusion strategies are insufficient.\n                  <\/jats:p>","DOI":"10.3389\/fcvm.2026.1868969","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T05:39:01Z","timestamp":1785389941000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Femoro-popliteal bypass with arterial perfusion cannula coupling of the VA-ECMO system to the prosthetic anastomosis in critical limb ischemia secondary to veno-arterial extracorporeal membrane oxygenation: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Rafael E.","family":"Castellar Martinez","sequence":"first","affiliation":[{"name":"Universidad Libre de Colombia Seccional Barranquilla","place":["Barranquilla, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria C.","family":"Urina Cabas","sequence":"additional","affiliation":[{"name":"Universidad Libre de Colombia Seccional Barranquilla","place":["Barranquilla, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andres C.","family":"Castellar Martinez","sequence":"additional","affiliation":[{"name":"Universidad Libre de Colombia Seccional Barranquilla","place":["Barranquilla, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Adonai Tolstano","sequence":"additional","affiliation":[{"name":"Universidad Libre de Colombia Seccional Barranquilla","place":["Barranquilla, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1097\/MAT.0000000000001510","article-title":"ELSO interim guidelines for 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Electrocardiol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"405","DOI":"10.3390\/medicina59020405","article-title":"Emergency management of electrical storm: a practical overview","volume":"59","author":"Guarracini","year":"2023","journal-title":"Medicina (Kaunas)"},{"key":"B12","doi-asserted-by":"publisher","first-page":"2189","DOI":"10.1016\/j.jacc.2023.03.424","article-title":"Multidisciplinary critical care management of electrical storm: JACC state-of-the-art review","volume":"81","author":"Jentzer","year":"2023","journal-title":"J Am Coll Cardiol"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1868969\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T05:39:03Z","timestamp":1785389943000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1868969\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,30]]},"references-count":12,"alternative-id":["10.3389\/fcvm.2026.1868969"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1868969","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,30]]},"article-number":"1868969"}}