Venovenous extracorporeal membrane oxygenation catheter related superior vena cava syndrome without pre-existing stenosis in an adult patient: a case report.

Background: The use of venovenous extracorporeal membrane oxygenation (VV ECMO) for severe adult respiratory failure is rapidly increasing worldwide. To date, no studies have documented early-onset superior vena cava (SVC) stenosis caused solely by ECMO cannula placement in adults without pre-existing anatomical abnormalities, leading to SVC syndrome.

Case presentation: We report the first case of SVC syndrome in an adult patient with pre-existing SVC angulation, exacerbated by cannula placement during VV ECMO therapy. Serial venous-phase chest CT scans (pre-ECMO and during ECMO support) demonstrated progressive luminal narrowing at the cannula tip site, correlating with clinical manifestations of SVC obstruction. The patient was successfully weaned from VV ECMO, achieved complete resolution of SVC syndrome symptoms, and was discharged without neurological sequelae.

Conclusions: This case provides definitive imaging evidence that ECMO cannula placement alone can induce acute SVC stenosis in patients with pre-existing vascular tortuosity. Our findings strongly advocate for pre-procedural vascular imaging assessment and real-time monitoring during ECMO support to mitigate this life-threatening complication.