LEGMO: Extremity Salvage Using Extracorporeal Membrane Oxygenation

Area of Science:

• Vascular Surgery
• Infectious Disease Management
• Medical Device Innovation

Background:

• Mycotic aneurysms pose complex surgical challenges, requiring simultaneous infection control and vascular reconstruction.
• Effective management necessitates balancing urgent debridement with the risk of re-infection in reconstructed areas.

Observation:

• A 47-year-old male patient presented with Pseudomonas sepsis, a non-functioning kidney transplant, and a ruptured, stented external iliac pseudoaneurysm.
• Initial treatment involved excision of the infected pseudoaneurysm and indwelling stents.

Findings:

• Limb perfusion was maintained using isolated limb perfusion with extracorporeal membrane oxygenation (ECMO).
• A staged extra-anatomic femoral-femoral bypass was performed after sepsis resolution.
• This innovative technique successfully preserved limb viability while awaiting definitive treatment.

Implications:

• This case highlights the potential of ECMO-supported limb perfusion as a viable strategy in complex mycotic aneurysm management.
• The staged approach allows for sepsis control prior to definitive vascular reconstruction, potentially improving outcomes.
• This method offers a solution for limb salvage in patients with critical infections and vascular emergencies.