The Chiari network is a fenestrated embryologic remnant in the right atrium, usually asymptomatic but occasionally involved in catheter entrapment. We report a rare case where a central venous catheter guidewire became entangled in the Chiari network and required surgical removal. A 68-year-old woman scheduled for off-pump coronary artery bypass surgery (OPCAB) underwent preoperative central venous catheter placement via the right internal jugular vein. During the procedure, resistance was encountered upon withdrawal of the guidewire. Intraoperative echocardiography and fluoroscopy revealed the tip of the guidewire in the right atrium. As traction resulted in significant resistance, we proceeded with surgical removal after completion of the bypass grafting. Under cardiopulmonary bypass, the right atrium was opened, revealing fibrous strands entangling the guidewire, consistent with a Chiari network. The entangled portion was excised, and the guidewire was safely removed without damage to adjacent structures. This case highlights the importance of considering Chiari network entrapment as a differential diagnosis when encountering resistance during central venous catheter placement. Surgical intervention should be considered when percutaneous retrieval is not feasible.

A 76-year-old man had increasing thoracic and abdominal aortic aneurysms. First, endovascular repair was performed on the thoracic descending aorta, but type Ib endoleak persisted due to severe aortic calcification. Additional treatment was planned since the maximum diameter of the thoracic and abdominal aortic aneurysms had increased to 75 and 70 mm, respectively. Due to the fact that aortic calcification was present from the aortic arch to the bilateral iliac arteries, which is sometimes referred to as porcelain aorta, conventional open thoracoabdominal aortic repair or hybrid repair using retrograde debranching seemed impossible. Therefore we performed antegrade visceral debranching from the ascending aorta followed by endovascular thoracoabdominal aortic repair successfully. For the thoracoabdominal aortic aneurysms which present difficulty in performing conventional open surgical repair or hybrid repair with retrograde debranching from the iliac artery. This technique can be an effective alternative strategy, but still needs further investigation, including its indications, due to the high surgical stress associated with the procedure.