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).