Background: Coronary angiography is an important diagnostic tool in patients with acute coronary syndrome. Case Report: We report a case of a 39-years-old male patient with severe peripheral arterial disease, who presented to us in cardiogenic shock. To establish an arterial line was the challenging corner stone for both extracorporeal membrane oxygenation and for heart catheter. Conclusion: We succeeded to ensure a safe and effective arterial way to catheterize the patient diagnostically and therapeutically through direct puncture of the ECMO arterial cannula.