Ever heard of the obturator vein?

We report a complication related to advancement of a large diameter long sheath in the obturator vein. In an adult with a previously thrombosed femoral vein, the obturator vein was inadvertently cannulated. During percutaneous pulmonary valve implantation, the Ensemble(R) delivery system could not be advanced after repositioning attempt. The obturator vein had been perforated and sheath was coiled up in the pelvis leading to a retroperitoneal pelvic hematoma. Continuity of the vein was established using two self-expanding covered stents. The obturator vein runs dorsally and joins the inferior caval vein at a very acute angle posterior in the pelvis, creating a corner in which stiff catheters or sheaths may get entrapped.