Lower limb amputation following arterial cannulation for VA-ECMO has been described in the literature. Limb ischemia however following venous cannulation is very rare and not quite understood. We present a case of limb ischemia following venous cannulation. A combination of venous congestion, compartment syndrome and subsequent arterial insufficiency is the proposed pathophysiology. Shock and use of vasopressors are compounding factors. Limb ischemia can be transient and reversible if diagnosed immediately and treated by early removal of the cannula. Our patient was unstable and ECMO dependent, and removal of the cannula was not an option. This resulted in limb loss and eventual above knee amputation. Use of the smallest appropriate venous cannula and early fasciotomy, in addition to hemodynamic optimization are measures that could help in preventing major amputation.

文献中描述了 VA-ECMO 动脉插管后的下肢截肢。然而，静脉插管后的肢体缺血非常罕见且未被完全了解。我们提出一例静脉插管后肢体缺血的病例。提出的病理生理学是静脉充血、筋膜室综合征和随后的动脉供血不足的组合。休克和血管加压药的使用是复合因素。如果立即诊断并通过早期拔除插管进行治疗，肢体缺血可能是短暂的和可逆的。我们的患者病情不稳定且依赖 ECMO，无法拔除插管。这导致肢体丧失并最终导致膝盖以上截肢。使用最小的适当静脉插管和早期筋膜切开术，