Background High bifurcation of the deep femoral artery (DFA) is rare in clinical practice, and patients with this variation are less likely to receive venoarterial extracorporeal membrane oxygenation (V-A ECMO) treatment. Therefore, the method by which V-A ECMO is introduced in patients with vascular variation is very important. Case presentation A 52-year-old male patient had ST elevation myocardial infarction due to coronary heart disease. Angiography showed tripartite coronary artery lesions, and coronary artery stenting supported by V-A ECMO was needed. Vascular evaluation before ECMO catheterization revealed high bifurcation of the bilateral DFA located at the inguinal ligament. After discussion, the perfusion cannula was placed in the left superficial femoral artery (SFA) towards the heart, and the distal perfusion catheter (DPC) was placed in the left SFA towards the distal end. Nevertheless, after the patient's heart recovered, necrosis of the toe of the left lower limb still occurred. Conclusion Common femoral artery assessment must be performed before V-A ECMO for patients with high bifurcation of the DFA. Incision catheterization and DPC placement are recommended. After decannulation, arterial repair under direct visualisation is recommended, and rigorous distal vascular assessment and management are needed.

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Background: Nowadays, minimally invasive intervention (MII) has largely replaced delayed open surgery in acute necrotizing pancreatitis (ANP). However, the timing of MII remains unclear. The present study investigated the effect of early versus delayed MII on complications in ANP. Methods: Studies evaluating the impact of the timing of MII on complications in ANP patients were thoroughly searched on PubMed, EMBASE, Cochrane Library, and Web of Science from inception to June 2022. The primary outcome of interest was mortality. Secondary outcomes were the incidence of complications. Results: Nine studies reporting 870 patients undergoing MII for ANP were included. No significant difference was found in mortality between the early and delayed intervention groups. In addition, the timing of MII was not associated with the incidence of new-onset respiratory failure, new-onset cardiovascular failure, new-onset renal failure, new-onset multiple organ failure, gastrointestinal fistula or perforation, pancreatic fistula, stent migration, bleeding, venous thrombosis, and new-onset pancreatic endocrine insufficiency. Notably, in the subgroup analysis of biliary and Asian ANP patients, early intervention was associated with a significantly higher risk of new-onset renal failure than delayed intervention. Conclusions: Early intervention is safe and recommended only for patients with indications for intervention, such as infection.

Background: High position deep femoral artery (DFA) bifurcation is rare in clinical practice, and patients with this variation are less likely to receive venoarterial extracorporeal membrane ox-ygenation （V-A ECMO） treatment. Therefore, it is of great significance to introduce the process of V-A ECMO in patients with vascular variation. Case pesentation: A 52-year-old male patient had ST elevated myocardial infarction (STEMI) due to coronary heart disease, angiography showed tripartite coronary artery lesions, and coronary artery stenting supported by V-A ECMO was required. Vascular evaluation before catheterization on ECMO found that the patient had high bifurcation of bilateral DFA, located at the inguinal ligament. After discussion, the perfusion cannula was placed in the left superficial femoral artery (SFA) toward the heart, and the distal perfusion catheter (DPC) was placed in the left SFA toward the distal end. Finally after the patient's heart recovered, necrosis of the toe of the left lower limb still occurred. Conclusion: Femoral artery (FA) assessment must be evaluated before V-A ECOM. To patients with high position DFA. Incision catheterization and DPC placement are recommended. After decannulation, arterial repair under direct vision was recommended, Rigorous distal vascular assessment and management is required.