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Updated: Jan 28, 2026

Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
A Very Unlucky Intraoperative Event During a Chimney Technique for Juxtarenal Aneurysm Exclusion
Jérémie Jayet1,2, Gael Bounkong1,2, Raphaelle Sylvestre1,2,3
1Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 9 Avenue Charles de Gaulle, 92104, Boulogne Cedex, France.
Abstract:
A two-vessel Ch-EVAR procedure was scheduled within the instructions for use of the devices. After deploying, it appeared that the long sheath inserted through an arm access was discovered to be trapped behind the aortic stentgraft barbs. Trying to remove the sheath, the graft was displaced upward and the procedure was converted for a three-vessel Ch-EVAR incorporating the superior mesenteric artery. Simultaneous ballooning of the target vessels and the stentgraft permitted to exert a strong pullback traction on the blocked sheath, allowing its removal. A segment of the sheath distal end was left trapped in the aortic stentgraft. At 12 months follow-up, the patient is free of any complications and there are no occlusions of the abdominal visceral branches or embolic events in peripheral arteries.
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