The Avalon dual lumen cannula is presently the cannula of choice for veno-venous extracorporeal membrane oxygenation (VV-ECMO) via right internal jugular cannulation. This cannula establishes VV-ECMO with a single cannulation; however, it requires appropriate positioning to gain adequate oxygenation. Malposition of this cannula can cause inadequate ECMO flow, hypoxia, and structural injury. We ...

OBJECTIVE By using a guidewire fixator, the distal guidewire position can be secured in an artery. This new principle enables a method for fenestrated endovascular aortic repair where the connection between the aortic branches and the stent graft fenestrations is made before inserting and deploying the stent graft. METHODS This is conducted using a fenestrated stent graft with preloaded cathe...

The aim of this report is to present a technical detail of use in the management of an anorectal malformation (ARM). A boy with ARM and a fistula to the urethra was operated on with a posterior sagittal anorectoplasty (PSARP). Before the PSARP operation, a videoendoscopy was performed through the distal stoma down to the distal end of the rectum. The rectourethral fistula was identified and a g...

Pancreaticojejunostomy stricture (PJS) is a late complication of pancreaticoduodenectomy. The endoscopic treatment of PJS is very challenging due to the difficulty of locating the small anastomotic site and passing the stricture using a guidewire. We herein report two cases of severe PJS. These patients could not be treated using only double-balloon endoscopy or endoscopic ultrasound-guided pun...

Patient 1 An 84-year-old woman with severe aortic stenosis was referred for coronary angiography before transcatheter aortic valve implantation. A severe stenosis in the mid segment of the right coronary artery was treated with a bare metal stent. The guidewire induced a new moderate focal lesion at the most proximal segment of this vessel (Figure 1A). OCT revealed images consistent with a rupt...

Placement of the Avalon Elite bicaval dual lumen cannula for venovenous extracorporeal membrane oxygenation (VV-ECMO) via the internal jugular vein requires precise positioning of the cannula tip in the inferior vena cava with echocardiography or fluoroscopy guidance. Correct guidewire placement is clearly the key first step in assuring proper advancement of the cannula. We report a case of une...

A case in which a 0.014" wire was broken during the sheath placement in the radial artery for transradial coronary procedure is described here, and a successful retrieval of it using conventional methods is also described. Through the left femoral artery, the 6 Fr guiding catheter was advanced down to the tip of the broken wire at the brachial artery, and the distal part of the broken guidewire...

Distal coronary artery perforation with an angioplasty guidewire is a rare complication that may cause cardiac tamponade, myocardial infarction, arrhythmia, and even death. The use of platelet IIb/IIIa glycoprotein receptor inhibitors increases the risk of potentially fatal complications that are difficult to manage. We report a patient on treatment with abciximab who presented coronary perfora...