case_images: PMC9520057_01
case_images: Pre-operative ultrasound images (a). Sterile preparation of the operative area (b). The clamping of arterial and venous cannulas at the distal part by four tubing clamp forceps (c). Direct puncture with seldinger technique in the proximal portion of the arterial cannula (d). The insertion of Terumo Stiff guidewire through the cannula (e). Removal of the arterial cannula under manual compression at the access by an assistant (f). Insertion of the first Perclose Proglide and deploying at the direction about 10-11 o' clock (g). Removal of the first Proglide and placement a clamp forcep to hold the two suture limbs together on the right side of the patient (h). Reinsertion of the guidewire to place the second Proglide and deploy at about 1-2 o' clock (i). Wrapping the railed suture limbs tightly around the left index finger to pull it (j). The hemostasis was adequate and cut the suture tails (k). Post-operative ultrasound images with normal blood flow of femoral artery (l).
case_images: fmed-09-980122-g0001.jpg
case_images: PMC9520057_01_fmed-09-980122-g0001.jpg
case_images: F1
case_images: Therefore, femoral artery ultrasound was estimated (Figure 1a) before catheter decannulation and marked when necessary. Then thoroughly sterile preparation for the cannulation area was in place (Figure 1b). Above all, the arterial and venous cannulas were instantly clamped at the distal part with four tubing clamp forceps (Maquet, Germany, 20 cm) (Figure 1c) before being cut with a scissor. After direct puncture with seldinger technique (Figure 1d) in the proximal portion of the arterial cannula (Maquet, Germany, 23 cm, 19 F), a 0.035-inch guidewire (Terumo Stiff Wire, Terumo, Japan, 150 cm) was advanced cautiously into to ascending aorta (Figure 1e), the VA-ECMO arterial cannula was withdrawn and removed under manual compression at the access by an assistant (Figure 1f). Subsequently, the first Proglide was inserted through the guidewire and continued to advance the device until a vigorous pulsating flow of blood was plainly obvious from the marker lumen, placed at about 10-11 o' clock (Figure 1g), then deployed the foot by lifting the lever (marker #1), gently pulled the device back, using the other hand to push on the plunger assembly (as shown in marker #2), disengaged the needles by pulling the plunger assembly back (as shown in marker #3) and dislodged the plunger and needles utterly. Reinserted the guidewire (Check-Flo Performer, Cook Medical, USA) maintaining an adequate length inside the artery and removed the first ProGlide (Figure 1h). Repeat aforementioned steps with the second ProGlide, which is placed at about 1-2 o' clock (Figure 1i) toward the patient's left side, and the other clamped suture were placed on the left side. Removed the clamp from the first suture, applied manual pressure proximal to the puncture site and wrapped the railed suture limb tightly around the left index finger to pull it (Figure 1j). The bleeding was controlled, and the hemostasis was adequate, ultimately cutting the suture tails below the surface of the skin (Figure 1k). After completing the procedure, we assessed the incision by ultrasound, the blood flow of femoral arterial signals was well-filled with no abnormal signals outside the blood vessels (Figure 1l).