title: Thrombosis of the Right Internal Jugular Vein is Not a Contraindication to Ambulatory Veno-Venous Extracorporeal Membrane Oxygenation with a Bicaval Dual-Lumen, Single Cannula System.
abstract: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an ever-emerging method of managing respiratory failure in patients who are refractory to conventional mechanical ventilatory support. An increasingly common method of cannulation involves placement of a bicaval dual-lumen, single cannula via the right internal jugular (IJ) vein. Thrombus in this vein has been considered a contraindication for cannula placement.
  
  
  
  A 45-year-old Hispanic male presented with bleomycin-induced respiratory failure resulting in acute respiratory distress syndrome (ARDS). Ambulatory VV-ECMO support was initiated, and during surgical cannula placement an occlusive thrombus was noted in the right IJ vein. A tract was dilated and the cannula was placed without any thromboembolic complications.
  
  
  
  This case demonstrates that cannulation for ambulatory VV-ECMO in the setting of an occlusive IJ thrombus can be safe and feasible.
authors.affiliation: Department of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Kronfli
authors.affiliation: Department of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA.
authors.forename: Chetan
authors.initials: C
authors.lastname: Pasrija
authors.affiliation: Department of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA.
authors.forename: Aakash
authors.initials: A
authors.lastname: Shah
authors.affiliation: Department of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Ghoreishi
authors.affiliation: Department of Cardiothoracic Surgery, Hahnemann University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Jose P
authors.initials: JP
authors.lastname: Garcia
authors.affiliation: Department of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA.
authors.forename: Si M
authors.initials: SM
authors.lastname: Pham
authors.affiliation: Department of Cardiothoracic Surgery, University of Washington Seattle, Seattle, Washington, USA.
authors.forename: Pablo G
authors.initials: PG
authors.lastname: Sanchez
authors.affiliation: Department of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA.
authors.forename: Zachary N
authors.initials: ZN
authors.lastname: Kon
mesh_terms: D000553:Ambulatory Care / Q000379:methods*; D057785:Catheters; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation*; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D020246:Venous Thrombosis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy