The case of extracorporeal membrane oxygenation (ECMO) catheter misplacement in the ascending lumbar vein

Liver Injury Due to Penetration of the Common Iliac Vein by an Extracorporeal Membrane Oxygenation Cannula

“…Vascular complications have been reported in 10% of adults who underwent an introduction of ECMO through the femoral artery, including acute embolism/thrombosis, dissection of the femoral artery, pseudoaneurysm, inguinal hematoma, femoral artery perforation, and compartment syndrome [ 3 ]. To date, several cases of ECMO cannulas straying into the ascending lumbar vein have been reported [ 5 , 6 ]. Generally, cannulas inserted into the left femoral vein are more likely to enter the ascending lumbar vein than those inserted into the right femoral vein.…”

“…In some previous cases, the cannula strayed into the ascending lumbar vein without causing problems with blood removal, suggesting that negative pressure for blood removal may not reveal hemorrhagic complications [ 6 ]. Although one report described a venous cannula straying into the ascending lumbar vein and its removal under X-ray fluoroscopic guidance after confirming minimal extravascular leakage of contrast medium [ 5 ], there is no report of surgical removal of the cannula found to date. In this case, it was confirmed by laparotomy that there was no damage to the duodenum, and the liver injury was hemostatically controlled.…”

“…Although previous reports have described an ECMO cannula punctured from the femoral vein straying into the ascending lumbar vein [ 5 , 6 ], injuries to other organs due to intraperitoneal penetration have not been reported to date. There has been a report in which surgical removal of the cannula was considered [ 5 ]. However, there are no reports of actual surgical removal of the cannula, and the appropriate removal method has not been established.…”

“…Complications associated with extracorporeal membrane oxygenation (ECMO) include hemorrhage and embolism, whereas complications associated with cannulation include perforation, arterial dissection, and cannula malposition [1][2][3][4]. Although previous reports have described an ECMO cannula punctured from the femoral vein straying into the ascending lumbar vein [5,6], injuries to other organs due to intraperitoneal penetration have not been reported to date. There has been a report in which surgical removal of the cannula was considered [5].…”

Two cases of catheters inserted from the femoral vein straying into the hepatic vein, possibly owing to a Eustachian valve: a case report

“…Therefore, it is assumed that catheter straying is less likely during insertion from the FV to the right atrium because the angle between the IVC and the HV is obtuse in this direction. In previous reports, guidewires inserted from the FV strayed into the ascending lumbar vein owing to the anatomical angle [ 10 , 11 ]. This problem is thought to be related to the acute angle formed by the ascending lumbar vein and the iliac vein.…”