TORSION AND KINKING OF UNSUPPORTED AORTIC ENDOGRAFTS - TREATMENT BY ENDOVASCULAR INTERVENTION

Purpose: To describe the management strategies used to deal with twist ed aortic endografts. Methods and Results: Two patients with successfu lly excluded aortic aneurysms developed symptoms referable to previous ly undetected twists in their endografts (one EndoVascular Technologie s [EVT] and one customized aortomonoiliac device). The limb graft occl usion in the EVT graft was treated surgically with a femorofemoral byp ass, but the aortomonoiliac endograft was salvaged with percutaneous i mplantation of a Wallstent. During another aortomonoiliac procedure, s uboptimal flow through the endograft was traced to contortion of the e ndograft as it passed over an angulated proximal aneurysm neck. An X-l arge Palmaz stent was deployed to support the graft at this point. Con clusions: Unsupported aortic endografts may develop twists and kinks d uring deployment that can lead to low outflow and graft occlusion. End ovascular techniques are available to repair these defects postoperati vely, although more precise intraoperative assessment tools may identi fy these problems so that they can be corrected at the initial interve ntion.