Bedside intravascular ultrasound-guided fibrin sheath balloon maceration and inferior vena cava filter placement during extracorporeal membranous oxygenation decannulation

Inferior vena cava filter placement during extracorporeal membranous oxygenation decannulation has been described as a technique to prevent potentially lethal pulmonary embolism in this critically ill population. With long-standing extracorporeal membranous oxygenation cannulae, venous fibrin sheaths may develop, which may predispose to filter maldeployment or inadequate embolus filtration. This report describes the use of a balloon catheter to disrupt a fibrin sheath at patient bedside using intravascular ultrasound guidance to facilitate inferior vena cava filter placement. (J Vasc Surg Cases and Innovative Techniques 2020;6:56-8.)