ID:24 FC-D09-4 Fluoroscopic-guided decannulation of a femoral venous ECMO cannula abutting an inferior vena cava filter

In patients with a pre-existing inferior vena cava (IVC) filter who require veno-arterial (VA) extracorporeal membrane oxygenation (ECMO), placement of a femoral venous drainage cannula abutting the IVC filter may result in the two devices becoming lodged together. This configuration can increase the risk of complications during cannulation or decannulation, including IVC filter migration, fracture, or venous injury. Therefore, when ECMO support is planned in patients with an IVC filter, venous drainage is preferably achieved via internal jugular vein cannulation or by femoral venous cannulation with the cannula tip placed below the level of the IVC filter. However, in emergency situations such as extracorporeal cardiopulmonary resuscitation (ECPR), femoral venous cannulation is often unavoidable. Despite this clinical challenge, reports describing safe decannulation strategies in patients with an indwelling IVC filter are scarce. We report a case of a patient with extensive pulmonary thromboembolism who underwent surgical pulmonary thrombo-embolectomy and IVC filter placement, followed by ECPR for sudden cardiac arrest. VA ECMO was established using femoral cannulation, with the venous drainage cannula positioned abutting the IVC filter. After weaning from VA ECMO, the femoral venous cannula was safely removed under fluoroscopic guidance on ECMO day 10, without any complication. When decannulation of VA ECMO is required in patients with a pre-existing IVC filter in whom the femoral venous cannula abuts the filter, fluoroscopic-guided decannulation may represent a safe and feasible strategy.