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(A) X-ray during veno-arterial extracorporeal membrane oxygenation. (B) The venous thrombus from the right atrium to the inferior vena cava. (C) Axial view of venous thrombus at the inferior vena cava.
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ECMO system was composed of a 25-Fr out-flow cannula at the left femoral vein and 15-Fr in-flow cannula at the right femoral artery (Fig. 1A). Emergency coronary angiography revealed total occlusion of the proximal left anterior descending artery, in which a stent was successfully placed. After removal of the ECMO cannulas, ultrasonography showed a huge venous thrombus, which was tubular and appeared like a template of the ECMO cannula, consecutively extending from the right atrium to the inferior vena cava up to the bifurcation of the common left iliac vein (Figs. 1B,C; Appendix video S1).