External femorofemoral bypass to relieve acute leg ischemia during circulatory assist

The development of limb ischemia in patients who are dependent on an intra-aortic balloon pump (IABP) and/or extracorporeal membrane oxygenation (ECMO) is a serious problem. We used external femorofemoral bypass grafting at the bedside as a salvage procedure in two such patients with effective reversal of ischemia, although both died of cardiac complications. This procedure can be considered in patients who are severely coagulopathic and are dependent on IABP and/or ECMO, in whom the graft removal would be considered at the time of balloon removal.