A rare case of superior vena cava syndrome in a patient on VV-ECMO

Abstract

Superior vena cava (SVC) syndrome is caused by either extrinsic compression of SVC or intrinsic lesions within SVC leading to obstruction of SVC and consequently swelling of the face, neck, and upper extremeities. Iatrogenic incidence is on the rise due to the use of long-term indwelling catheters. SVC syndrome in extracorporeal membrane oxygenation (ECMO) has been defined in neonatal and paediatric ECMO cases. Only one case of SVC syndrome in adult has been defined while using a double-lumen ECMO cannula. Our case describes a case of SVC syndrome in a case on veno-venous ECMO (VV-ECMO) with an internal jugular vein (IJV) return cannula which is unheard of. A high index of suspicion is required to diagnose SVC syndrome.

Neck Swelling in a Critically Ill Patient With COVID-19-Related Acute Respiratory Distress Syndrome on Venovenous Extracorporeal Membrane Oxygenation: Consider the Differential

“…The incidence of severe neck and facial swelling during ECMO has not been well-described, and it has been described only in case reports [ 1 , 2 ]. Of these cases, they describe the onset of SVC syndrome resulting from venous obstruction due to the ECMO catheters.…”

“…The development of neck swelling and facial edema during venovenous extracorporeal membrane oxygenation (VV-ECMO) usually heralds potentially serious complications in pediatric and adult ECMO, such as superior vena cava (SVC) obstruction [ 1 , 2 ]. Improper cannula sizing could lead to partial or complete venous obstruction.…”

“…Improper cannula sizing could lead to partial or complete venous obstruction. In pediatric patients, SVC flow obstruction from large ECMO cannulae may occur due to mechanical obstruction in the setting of a narrow blood vessel, but it has rarely been described in adults, most likely due to larger blood vessels in this population [ 1 , 2 ]. For most adult patients, the typical internal jugular vein ECMO cannula size may range from 15-32 French (Fr) depending on the cannula and ECMO configuration (i.e., single versus dual-lumen cannula).…”

“…Additionally, ECMO cannula selection in Fr sizing could be aided with ultrasonography by measuring the diameter (D) of the target blood vessel and using the formula (Fr = D (in mm) × 3) [ 3 ]. However, there have been some isolated case reports in adults of SVC syndrome occurring in patients with both single-lumen and double-lumen catheters [ 1 , 2 ].…”

Venous thromboembolic events in the setting of extracorporeal membrane oxygenation support in adults: A systematic review

“…Overall, upper extremity DVTs have been characterized in the literature, but there is insufficient data to make any generalizable claims about localization of DVT with confidence. Rare yet deadly types of VTE including inferior vena cava (IVC) and superior vena cava (SVC) thrombosis and even SVC syndrome in the setting of ECMO have also been reported in some case reports [21,30,31]. Risk of VTE is not only during the period of ECMO use, it is also seen after decannulation [32].…”