Femoral artery variation was found during V-A ECMO catheterization: a case report

Background: High position deep femoral artery (DFA) bifurcation is rare in clinical practice, and patients with this variation are less likely to receive venoarterial extracorporeal membrane ox-ygenation （V-A ECMO） treatment. Therefore, it is of great significance to introduce the process of V-A ECMO in patients with vascular variation. Case pesentation: A 52-year-old male patient had ST elevated myocardial infarction (STEMI) due to coronary heart disease, angiography showed tripartite coronary artery lesions, and coronary artery stenting supported by V-A ECMO was required. Vascular evaluation before catheterization on ECMO found that the patient had high bifurcation of bilateral DFA, located at the inguinal ligament. After discussion, the perfusion cannula was placed in the left superficial femoral artery (SFA) toward the heart, and the distal perfusion catheter (DPC) was placed in the left SFA toward the distal end. Finally after the patient's heart recovered, necrosis of the toe of the left lower limb still occurred. Conclusion: Femoral artery (FA) assessment must be evaluated before V-A ECOM. To patients with high position DFA. Incision catheterization and DPC placement are recommended. After decannulation, arterial repair under direct vision was recommended, Rigorous distal vascular assessment and management is required.