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Annals of Intensive Care
Fig. 2 | Annals of Intensive Care

Fig. 2

From: Fluoroscopy-guided simultaneous distal perfusion as a preventive strategy of limb ischemia in patients undergoing extracorporeal membrane oxygenation

Fig. 2

Percutaneous insertion of a distal perfusion catheter. a Under fluoroscopy guidance, a sheath at the contralateral common femoral artery (CFA) was inserted using a micropuncture needle followed by a 0.018-inch nitinol wire. b A hydrophilic wire was advanced from the sheath of the contralateral CFA (through the aortic bifurcation and the ipsilateral common iliac artery, between the arterial ECMO cannula and the vessel wall of the ipsilateral common iliac artery) to the distal portion of the ipsilateral superficial femoral artery (SFA). c The proximal SFA ipsilateral to the arterial cannula was punctured using a micropuncture needle followed by a 0.018-inch nitinol wire as the reference point of the previously placed wire (yellow arrow heads). A distal perfusion catheter (6- or 7-Fr. sheath) was inserted antegrade and advanced safely into the mid-SFA. d The distal perfusion catheter was attached to the side port of the arterial cannula using 6-inch extension tubing with an intervening three-way stopcock

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