Torsion and kinking of unsupported aortic endografts: treatment by endovascular intervention.
OBJECTIVE
To describe the management strategies used to deal with twisted aortic endografts.


RESULTS
Two patients with successfully excluded aortic aneurysms developed symptoms referable to previously undetected twists in their endografts (one EndoVascular Technologies [EVT] and one customized aortomonoiliac device). The limb graft occlusion in the EVT graft was treated surgically with a femorofemoral bypass, but the aortomonoiliac endograft was salvaged with percutaneous implantation of a Wallstent. During another aortomonoiliac procedure, suboptimal flow through the endograft was traced to contortion of the endograft as it passed over an angulated proximal aneurysm neck. An X-large Palmaz stent was deployed to support the graft at this point.


CONCLUSIONS
Unsupported aortic endografts may develop twists and kinks during deployment that can lead to low outflow and graft occlusion. Endovascular techniques are available to repair these defects postoperatively, although more precise intraoperative assessment tools may identify these problems so that they can be corrected at the initial intervention.
Department of Surgery, Leicester Royal Infirmary, United Kingdom.
J R
JR
Boyle
M M
MM
Thompson
E G
EG
Clode-Baker
J
J
Green
A
A
Bolia
G
G
Fishwick
P R
PR
Bell
D000368:Aged; D000714:Anastomosis, Surgical; D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D005263:Femoral Artery / Q000601:surgery; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation