A sentrant sheath was used as a conduit during an endovascular aneurysm repair (evar) procedure.Due to severe bilateral iliac tortuosity and a right common iliac aneurysm, evar was scheduled after embolization of the right internal iliac artery coil.It was reported during the index procedure, the catheter was attempted to be advanced from the ipsilateral cannulation site but manipulation of the catheter could not be performed adequately due to severe iliac tortuosity.Right iia cannulation was attempted from the contralateral side (left) however again due to severe iliac tortuosity difficulty was encountered in manipulating the catheter.The 18fr sentrant was inserted and brought up to the terminal aorta and cannulation of the right iia was continued however the sentrant sheath dislodged downwards to the distal side due to the difficulties in cannulation and advancement.While inserting the sheath again and advancing to the terminal aorta, the left eia was damaged.The patient's blood pressure dropped and occlusion was performed with a reliant balloon (rel46j) from the right side.At this time the physician decided to convert to open and placed an abdominal artificial blood vessel and completed the procedure.Per the physician the cause of the vessel damage was anatomy related due severe iliac tortuosity which restricted manipulation of the catheter.It was also noted that user error may have contributed including the size of the sheath used during the procedure.No additional clinical sequelae were reported and the patient is fine.
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