Figure 4. Advancement of a guidewire to the biloma through the defect at the right posterior hepatic duct using a Crusade catheter.

(A) A right oblique radiograph shows the advancement of one guidewire (arrow) to the segment 8 bile duct and another guidewire (arrowhead) to the biloma. The two markers of the Crusade catheter are observed (white arrows).

(B) A schematic drawing shows a guidewire (blue) that was advanced to the segment 8 bile duct, which was used as a safety wire. The Crusade catheter is advanced on the first guidewire along the rapid-exchange lumen. The position of the Crusade catheter is adjusted to advance the second guidewire (yellow) to the right posterior hepatic duct through the over-the-wire lumen. The second guidewire (yellow) is then advanced to the biloma (brown) through the defect at the right posterior hepatic duct.

Image credit: Authors Manufacturer details: Crusade catheter; Kaneka Corporation, Minato City, Tokyo, Japan