Case report: Catastrophic thrombotic complication of the VA-ECMO circuit following TEVAR in a patient with sickle cell anemia. ​

Abstract

Mechanical circulatory support in sickle cell anemia patients undergoing complex cardiovascular surgery remains a subject of controversy. This is due to the risk of vaso-occlusive and prothrombotic phenomena associated with hypoxia, acidosis, inflammation, and contact with non-endothelialized surfaces. However, veno arterial extracorporeal membrane oxygenation (VA-ECMO) is employed as a rescue therapy in refractory shock scenarios. We describe the case of a 62-year-old patient with a history of sickle cell anemia and thoracic endovascular aortic repair (TEVAR), who was admitted for massive hemoptysis and severe hypoxemic respiratory failure. Imaging findings suggested infection of the aortic endoprosthesis. The patient underwent complex reconstruction of the aortic arch and ascending aorta, complicated by massive bleeding, requiring emergency left pneumonectomy. Patient developed refractory shock and deoxygenation requiring VA-ECMO. Thirty minutes later, the circuit presented massive thrombosis, resulting in a fatal outcome. This case underscores the profound risks associated with the convergence of sickle cell anemia, complex aortic surgery, and VA-ECMO. ​