Fluoroscopic-Guided Decannulation of a Femoral Venous Extracorporeal Membrane Oxygenation Cannula Traversing an Inferior Vena Cava Filter

In patients with an indwelling inferior vena cava (IVC) filter who require venoarterial (VA) extracorporeal membrane oxygenation (ECMO), placement of a femoral venous drainage cannula may cause the two devices to become mechanically engaged. This configuration heightens the risk of complications at both cannulation and decannulation, including IVC filter migration, fracture, or venous injury. Despite this clinical challenge, reports describing safe VA ECMO decannulation approaches in patients with indwelling IVC filters are scarce; consequently, procedural guidance remains limited. We report the case of a patient with extensive pulmonary thromboembolism who underwent surgical pulmonary thrombectomy and IVC filter placement, followed by extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest. Venoarterial ECMO was established using femoral cannulation with a venous drainage cannula traversing through the IVC filter. After weaning from VA ECMO, the femoral venous cannula was safely removed under fluoroscopic guidance on ECMO day 10 with no procedural complications. When decannulation of VA ECMO is required in patients with an indwelling IVC filter through which the femoral venous cannula traverses, fluoroscopy-guided decannulation can represent a safe and feasible strategy.