Perioperative venous thromboembolism salvage via VA-ECMO-bridged surgical thrombectomy: A case report

Deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) represent critical postoperative complications, often characterized by an insidious onset and underappreciated risk. We present a case of a 47-year-old paraplegic male who developed sudden hypoxemia and hemodynamic collapse on postoperative day 10 following cervical vertebroplasty. Bedside echocardiography promptly confirmed high-risk PE with right ventricular strain. In cases where pharmacologic thrombolysis was ineffective, emergent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was instituted to provide circulatory support, thereby ensuring safe inter-hospital transfer. Subsequent imaging revealed right main pulmonary artery occlusion and bilateral iliac vein thrombosis. A multidisciplinary team executed a combined strategy of iliac vein filter placement and surgical thrombectomy, achieving complete clot removal. VA-ECMO support was successfully weaned within 48 hours, followed by full cardiopulmonary recovery. This case underscores several key principles in managing catastrophic PE: (1) the imperatives of maintaining a high index of suspicion for venous thromboembolism in immobilized postoperative patients with acute clinical deterioration; (2) the pivotal role of bedside ultrasound as a rapid diagnostic tool when pulmonary angiography is not immediately obtainable; (3) the utility of VA-ECMO as a vital rescue and bridge therapy in pharmacologically refractory, unstable PE; and (4) the critical importance of a coordinated, time-sensitive, multidisciplinary pathway from diagnosis to definitive surgical intervention for survival.