Intravascular Retrieval of a Kinked Inferior Vena Cava Cannula Complicating Venovenous Extracorporeal Life Support

Cannula malpositioning is one of several complications recognized during the insertion of cannulas for extracorporeal life support that can lead to loss of cannula function or more serious injury due to vessel perforation. In the absence of vessel perforation, repositioning the cannula is often sufficient to restore function. We report a case of a kinked femoral drainage cannula with folding and retroflexion in the inferior vena cava (IVC) that was successfully repositioned with intravascular intervention. A 41-year-old woman was placed on venovenous extracorporeal life support (VV ECLS) for near-fatal asthma-induced hypercapnic respiratory failure following successful resuscitation from cardiac arrest. Emergent cannulation of the left femoral vein and right internal jugular vein was completed without difficulty. Subsequent imaging revealed the 55 cm 25 Fr drainage cannula was kinked in the mid-IVC with the tip retroflexed and terminating in the lower IVC. Drainage was adequate for VV ECLS. Since simple withdrawal of the cannula for decannulation was not possible, the patient successfully underwent a complex snare-assisted retrieval in the interventional suite after a run time of 101 hours. Her subsequent course was eventful, but she recovered and was discharged after 29 days.