Introduction
Mesenteric ischemia (MI) is a life-threatening disorder with almost half
of the cases caused by embolisms of cardiac origin. If left untreated,
severe hypoperfusion can lead to intestinal transmural necrosis,
peritonitis, sepsis, free intra-abdominal air, or extensive gangrene,
thus requiring prompt surgical intervention
[1]. In the presence of
pulmonary embolism (PE), a mortality rate of 30% adds on. Cardiogenic
shock (CS) resulting from right ventricular (RV) failure secondary to
hemodynamic collapse from primary PE is considered the most common cause
of early death, particularly in the first 7 days of diagnosis with a
superimposed 30-50% mortality risk
[2]. The high mortality
associated in said dual clinical presentation, deems surgical
intervention to be the main therapeutic approach.
Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) support can
provide acute support in CS or advanced heart failure (HF) with survival
rates ranging from 20 to 50%
[3]. Indocyanine green
fluorescent angiography (ICG-FA), has gained popularity as a
trans-operative visual aid tool for the assessment of tissue perfusion.
Thus far, ICG-FA has proven its capability to improve recognition of
perfusion threshold indices in clinical-decision making in construction
of tissue anastomoses and ischemia prevention
[4]. While current
surgical tendencies consider noncardiac surgical procedures (NCSPs) in
patients under ECMO support non-challenging, the case report herein
presented confronts this concept by introducing ICG-FA as a visual aid
tool in the performance of multiple abdominal surgeries during
extracorporeal life support (ELS).