Song Xiao, Wang Jian, Zong Liang, Jiang Hui, Shi Di, Zhu Huadong
Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
BMC Pulm Med. 2025 Aug 6;25(1):375. doi: 10.1186/s12890-025-03851-2.
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.
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.
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.
在全球范围内，静脉-静脉体外膜肺氧合（VV ECMO）用于治疗成人严重呼吸衰竭的情况正在迅速增加。迄今为止，尚无研究记录在没有既往解剖学异常的成人中，仅因ECMO插管置入导致的早发性上腔静脉（SVC）狭窄并引发SVC综合征。
我们报告了首例SVC综合征成人患者，该患者存在SVC成角情况，在VV ECMO治疗期间因插管置入而加重。系列静脉期胸部CT扫描（ECMO前和ECMO支持期间）显示插管尖端部位管腔逐渐变窄，与SVC梗阻的临床表现相关。患者成功脱离VV ECMO，SVC综合征症状完全缓解，出院时无神经后遗症。
该病例提供了确凿的影像学证据，表明在存在血管迂曲的患者中，仅ECMO插管置入即可诱发急性SVC狭窄。我们的研究结果强烈主张在ECMO支持前进行血管影像学评估以及实时监测，以减轻这种危及生命的并发症。
