An extracorporeal membrane oxygenator (ECMO) is used to support the heart and lungs in patients with severe cardiogenic shock and respiratory failure. When these cases occur in hospitals that cannot provide ECMO care, the interhospital transport of ECMO is necessary. Since November 2014, Bangkok Hospital has had 3 ECMO cases from Chiangmai, Trad and Pattaya respectively. There were no complications with establishing ECMO during transportation. Two of the patients survived, although they developed deep vein thrombosis after the removal of ECMO. Unfortunately one patient suffered pulmonary hemorrhage and died from circuit thrombosis due to pulmonary hemorrhage.

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uxtarenal aortic aneurysms (JRA) account for approximately 15% of abdominal aortic aneurysms. 1 By definition, suprarenal aortic crossclamping is required for surgical repair, causing temporary renal artery occlusion that may lead to postoperative renal dysfunction, in some case requiring (temporary) hemodialysis. Standard endovascular aneurysm repair (EVAR) is not an option due to inadequate landing zone for the graft below the renal vessels. Hence fenestrated and branched aortic endografts have been developed to treat high risk patients unfit for open surgery and anatomically unsuitable for standard EVAR. However, procedures are complex, technically challenging, and time consuming. 2,3 Case Report A 74-year-old man with a past medical history of hypertension, dyslipidemia, ischemic heart disease, chronic renal insufficiency and peripheral vascular disease, underwent right total knee replacement in March 2018. Postoperative kidney ultrasonography was performed due to renal insufficiency which revealed an abdominal aortic aneurysm. His computed tomography (CT) scan of the thorax, abdomen, and pelvis showed a large pararenal abdominal aortic aneurysm (7.8x6.8 cm) (Figure 1).

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