Li K, Pan XJ, Liu TT, Guo HY, Fang XL. Rare complication of extracorporeal membrane oxygenation cannula misplacement into the hepatic vein: A case report. World J Gastrointest Surg 2025; 17(5): 105023 [DOI: 10.4240/wjgs.v17.i5.105023]
Corresponding Author of This Article
Xue-Ling Fang, Professor, Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Shangcheng District, Hangzhou 310000, Zhejiang Province, China. xuelingfang@zju.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. May 27, 2025; 17(5): 105023 Published online May 27, 2025. doi: 10.4240/wjgs.v17.i5.105023
Rare complication of extracorporeal membrane oxygenation cannula misplacement into the hepatic vein: A case report
Kun Li, Xue-Jia Pan, Ting-Ting Liu, Hong-Yu Guo, Xue-Ling Fang
Kun Li, Ting-Ting Liu, Xue-Ling Fang, Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Xue-Jia Pan, Department of Nursing, Hangzhou Xiaoying Community Health Service Center, Hangzhou 310000, Zhejiang Province, China
Hong-Yu Guo, Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Co-first authors: Kun Li and Xue-Jia Pan.
Author contributions: Fang XL and Li K designed the study; Li K, Pan XJ, Guo HY, and Liu TT collected the images; Li K and Pan XJ wrote the original draft; Fang XL and Li K reviewed the manuscript. All authors contributed to the drafting of the manuscript and have reviewed and approved the final version. Li K and Pan XJ contributed equally to this work.
Supported by General Scientific Research Project of the Zhejiang Provincial Department of Education, No. Y201941857; and the Medical Science and Technology Project of Zhejiang Province, No. 2019RC170.
Informed consent statement: The family of the patient provided written informed consent for the publication of the case details and images before the condition of the patient had worsened. They were informed in detail that the information would be used for academic purposes.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xue-Ling Fang, Professor, Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Shangcheng District, Hangzhou 310000, Zhejiang Province, China. xuelingfang@zju.edu.cn
Received: January 9, 2025 Revised: February 25, 2025 Accepted: March 14, 2025 Published online: May 27, 2025 Processing time: 134 Days and 11.1 Hours
Abstract
BACKGROUND
Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is a lifesaving intervention for severe respiratory failure; however, its effectiveness depends on accurate cannulation-patients with anatomical variations present with significant challenges during the procedure.
CASE SUMMARY
We describe the case of a 56-year-old woman with severe pulmonary infection and acute respiratory failure managed with V-V ECMO. During the initial cannulation, a 23Fr venous drainage cannula was inadvertently inserted into the middle hepatic vein (HV) instead of the inferior vena cava (IVC) owing to the enlargement of the HV (1.02 cm diameter) and its acute angle (77.78°) relative to the IVC. This misplacement led to extracorporeal membrane oxygenation (ECMO) flow issues which were resolved after repositioning the cannula under real-time ultrasonographic and fluoroscopic guidance. This correction stabilized the patient’s condition and restored effective ECMO function, preventing severe complications such as liver injury and liver failure.
CONCLUSION
In clinical practice, real-time ultrasonography and fluoroscopy are critical in preventing cannulation errors in patients with anatomical variations. Vigilant imaging and precise techniques are essential for optimizing ECMO management and effectively addressing complications.
Core Tip: Veno-venous extracorporeal membrane oxygenation (ECMO) is a vital intervention for severe respiratory failure, but anatomical variations can complicate the procedure. Anatomical variations of the middle hepatic vein, for example, may hinder cannula placement, leading to insufficient flow and severe complications such as liver injury or failure. Real-time ultrasonography and fluoroscopy are essential for detecting and correcting cannula misplacement, ensuring optimal ECMO function, and preventing serious complications. Careful imaging and precise technique are crucial, particularly in patients with anatomical anomalies.
