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This article is the author's final published version in the Journal of Vascular Surgery Cases, Innovations and Techniques, Volume 9, Issue 2, June 2023, Article number 101121.

It was first presented as a poster at the Thirty-sixth Annual Meeting of the Eastern Vascular Society, Philadelphia, PA, September 29 - October 1, 2022.

The published version is available at Copyright © 2023 The Authors. Published by Elsevier Inc. on behalf of Society for Vascular Surgery.


Objective: Extracorporeal membrane oxygenation (ECMO) support for patients with cardiac or respiratory failure has been increasingly used by advanced critical care practitioners. The thromboembolic complications of ECMO have been extensively discussed and researched; however, research and discussion on the development, risks, and management of cannulae-associated fibrin sheaths are lacking.

Methods: Institutional review board approval was not required. We have presented three cases detailing the identifi- cation and individualized management of ECMO-associated fibrin sheaths at our institution. The three patients provided written informed consent for the report of their case details and imaging studies.

Results: Of our three patients with ECMO-associated fibrin sheaths, two were managed successfully with anticoagulation alone. One could not receive anticoagulation therapy and underwent inferior vena cava filter placement.

Conclusions: Fibrin sheath formation around indwelling ECMO cannulae is an unresearched complication of ECMO cannulation. We would recommend an individualized approach to the management of these fibrin sheaths and have provided three examples of successful management.

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Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.