Kinked Femoral Veno-Venous Extracorporeal Membrane Oxygenation Cannula Successfully Removed Using a Balloon-Assisted Percutaneous Approach: A Case Report

We report a case of safe percutaneous removal of a kinked venous access cannula from the inferior vena cava using a crossover balloon-assisted technique under fluoroscopic guidance in a patient receiving femoro-femoral veno-venous extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome following massive aspiration. After cessation of ECMO flow and clamping of both cannulas, a sheath-in-cannula technique was used by inserting 7F introducer sheaths into the access and return cannulas to maintain vascular access. A balloon catheter was advanced anterogradely into the proximal part of the kinked cannula to seal the fenestrations, and another balloon was inserted retrogradely in a crossover technique via the return cannula into the tip of the access cannula to facilitate redirection. Controlled balloon inflation enabled gentle traction and realignment across the iliac bifurcation, allowing safe extraction under continuous fluoroscopic guidance while avoiding injury to the inferior vena cava. This minimally invasive approach may represent an alternative to surgical removal of malpositioned ECMO cannulas in experienced centers.