title: In situ bending of thoracic stent grafts: clinical application of a novel technique to improve conformance to the aortic arch.
abstract: OBJECTIVE
  A straight thoracic stent graft often complies poorly with the curvature of the aortic arch. We have previously reported an in vitro model of a modified stent graft that can be bent in situ after deployment to improve conformance to the aortic arch. We now report the first clinical experience with this technique in three consecutive patients.
  
  
  METHODS
  Between September 2007 and August 2008, three patients were treated for different pathologies of the aortic arch with a modified thoracic stent graft that was fitted with a sliding self-locking knot and a detachable Bowden cable. Transfemoral traction on the Bowden cable enables controlled shortening of the proximal part of the stent graft at the inner curve after deployment. The stent graft is thereby directed to allow for better apposition to the aortic wall.
  
  
  RESULTS
  The modified thoracic stent grafts were correctly orientated and deployed in all patients. Transfemoral traction on the Bowden cable successfully bent all stent grafts and improved vessel wall apposition without a residual gap on the inner curve. The Bowden cable was successfully released and withdrawn in all patients.
  
  
  CONCLUSIONS
  In situ bending of thoracic stent grafts with a sliding self-locking knot is feasible and improves proximal apposition of the device at the inner curve of the aortic arch. More data and longer follow-up are required to confirm the applicability of this technique.
authors.affiliation: Vascular Center Malmö-Lund, Malmö University Hospital, Malmö, Sweden. tilokoelbel@googlemail.com
authors.forename: Tilo
authors.initials: T
authors.lastname: Kölbel
authors.forename: Nuno
authors.initials: N
authors.lastname: Dias
authors.forename: Timothy
authors.initials: T
authors.lastname: Resch
authors.forename: Jan
authors.initials: J
authors.lastname: Holst
authors.forename: Björn
authors.initials: B
authors.lastname: Sonesson
authors.forename: Martin
authors.initials: M
authors.lastname: Malina
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D003187:Compliance; D005260:Female; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome