(5-8) In our case, a snare device was successfully utilized to retract the bullet from the IVC into the left common femoral vein
This short-axis image shows a normal common femoral vein
at the greater saphenous vein junction in the groin.
Venography was performed and showed a large variceal collateral conglomerate around the stoma with variceal anastomosis with the right common femoral vein
The left IVC, the medial part of the left renal vein, the proximal part of the left suprarenal vein, the left common and external iliac vein, and also the left common femoral vein
were found to be clotted (Fig.
Venous Doppler echography showed thrombosed left common femoral vein
, thrombosed external and internal iliac veins with hypoechoic thrombus, inferior vena cava identified only at the origin, with reduced caliber, permeable right venous axis.
As far as the venous segments affected by CVI in our population, we found in all 32 cases the insufficiency of the GSV system, with reflux pattern involving also the SSV in 5 cases, the common femoral vein
in 13 cases, the popliteal vein in 2 cases, and finally the gastrocnemius vein in 2 cases.
After removal of the sheath from the common femoral vein
, the puncture site was manually compressed until haemostasis was achieved, and a light compression bandage was applied for at least 6 h.
The absence of the right common iliac vein, right external & internal iliac veins and right proximal common femoral vein
was also seen.
In 37 (90.2%) cases conventional angiography was advised while in 4 (9.7%) cases who presented very early (one in shock after lumbar disc surgery, other with expanding hematoma due to missed common femoral vein
injury and 2 cases of common femoral artery thrombosis after coronary angiography) it was not done.
ECMO=extracorporeal membrane oxygenation, M=male, ARDS=acute respiratory distress syndrome, F=female, MVA=motor vehicle accident, LCFV=left common femoral vein
. Table 2 Summary of ECMO cannulation and clinical course Patient ECMO cannulation Days: ECMO/ non-ECMO related ventilation complications 1 V-V: RIJV Avalon 24/24 Right haemothorax: double lumen requiring catheter thoracotomy 2 V-V: RIJV/RCFV access 24/29 Right empyema: with LCFV return requiring decortication 3 V-V: RIJV/RCFV access 11/22 with LCFV return 4 V-A: LCFV to RCFA 3/8 Urgent MVR/CABG.
Other venous accesses such as the common femoral vein
are prone to infection.
Puggioni et al (2006) encountered extension of thrombus into the common femoral vein
in 2.3% of their patients undergoing EVLT (Puggioni et al 2006).