Angiographic Evaluation of Lower Extremity Acute Limb Ischemia in an ECMO Patient Using Bedside Portable X-Ray

A 47-year-old patient was emergently placed onto venoarterial extracorporeal membrane oxygenation on postoperative day 1 after coronary artery bypass surgery for refractory ventricular tachycardic arrest. The patient subsequently lost pulses in the right lower extremity and was too unstable to be transported for a computed tomography scan or to the hybrid operating room for an angiogram. Bedside administration of contrast via the perfusion sheaths with concurrent portable radiograph allowed for imaging of the right lower extremity vasculature to assess for patency. This technique can facilitate rapid diagnosis and decision-making in a critically ill patient, avoiding high-risk transportation and/or unnecessary vascular procedures.