Femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used as an ultima ratio to maintain circulation in patients with refractory cardiorespiratory failure, but is also associated with vascular and ischemic complications. Buttock ischemia appears to be an underreported complication in these patients. 

 

Methods: In this retrospective single-center case series over a five-year period, all patients who received femoral VA-ECMO and survived for more than 24 hours were screened for buttock ischemia. Buttock ischemia was diagnosed using a two-step approach, which involved identifying characteristic skin lesions and CT scans suggesting hypoperfusion of the ipsilateral internal iliac artery.

Over the five-year period, 264 patients were assessed for buttock ischemia, which occurred in seven patients, with an average annual incidence of 2.7%. Unilateral buttock ischemia was observed in six patients, while bilateral buttock ischemia was seen in one patient and led to multiple surgeries in three patients. The CT scans showed that, in all cases, the arterial ECMO cannula covered the origin of the internal iliac artery and revealed additional bilateral atherosclerotic lesions in the iliac arteries.

Buttock ischemia is a rare and not fully understood complication of femoral VA-ECMO but may lead to clinically significant sequelae. Widespread knowledge and awareness are therefore important to recognize buttock ischemia, followed by individualized strategies for selecting and positioning the arterial cannula.