Ipsilateral lower extremity ischemia is a common and morbid complication during veno-arterial extracorporeal membrane oxygenation (VA-ECMO). The cannula can impede ipsilateral distal arterial flow leading to critical limb ischemia. Cannula size, placement, and utilization of distal perfusion catheters are strategies that have been used to prevent this complication. We report the novel case of a 19-year-old female on VA-ECMO complicated by contralateral lower extremity ischemia. Diagnosis was made by computed tomography, and with repositioning of the femoral arterial cannula, she had a complete resolution of symptoms.
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