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Kinking of Frozen Elephant Trunk Hybrid Prostheses: Incidence, Mechanism, and Management
INTRODUCTION: Kinking of the Frozen Elephant Trunk (FET) stent graft is one of the most devastating complications of the FET procedure. It can present post-operatively with reduced arterial pressures in the lower limbs and intermittent claudication. However, it can also be visualized intra-operative...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9091648/ https://www.ncbi.nlm.nih.gov/pubmed/35571190 http://dx.doi.org/10.3389/fcvm.2022.912071 |
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author | Kayali, Fatima Qutaishat, Sara Jubouri, Matti Chikhal, Rohan Tan, Sven Z. C. P. Bashir, Mohamad |
author_facet | Kayali, Fatima Qutaishat, Sara Jubouri, Matti Chikhal, Rohan Tan, Sven Z. C. P. Bashir, Mohamad |
author_sort | Kayali, Fatima |
collection | PubMed |
description | INTRODUCTION: Kinking of the Frozen Elephant Trunk (FET) stent graft is one of the most devastating complications of the FET procedure. It can present post-operatively with reduced arterial pressures in the lower limbs and intermittent claudication. However, it can also be visualized intra-operatively by the surgeons. Unresolved kinking of the stent graft can result in intraluminal thrombus formation and subsequent multi-organ septic emboli. AIMS: The main scope of this review is to collate, summarize and present all the evidence in the literature on kinking of FET stent grafts. METHODS: We carried out a comprehensive literature search on multiple electronic databases including PubMed, EMBASE, Ovid, and Scopus to collate all research evidence on the incidence, mechanism, and management of FET graft kinking. RESULTS: Incidence of kinking is variable, ranging from 0% to 8% in the literature, with varying rates associated with each stent graft type. The Thoraflex Hybrid(TM) prosthesis seemed to be the most commonly used and superior graft, and out of all the 15 cases of kinking reported in the literature, 5 (33.3%) were associated with just the Frozenix graft which had the highest incidence. There are multiple theories regarding the mechanism of kinking, including the direction of blood flow, the length of the stent grafts used, and the position of the prosthesis in relation to the flexure of the aorta. Multiple reparative management techniques have been suggested in the literature and include total endovascular repair, open repair, balloon dilatation, and deploying a second stent graft. CONCLUSION: Graft kinking is one of the most critical complications of the FET technique. Its life-threatening sequelae warrant appropriate follow-up of these patients post-operatively, in addition to time management if kinking is suspected. Given the limited evidence in the literature, future studies should incorporate graft kinking into their outcomes reporting. |
format | Online Article Text |
id | pubmed-9091648 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-90916482022-05-12 Kinking of Frozen Elephant Trunk Hybrid Prostheses: Incidence, Mechanism, and Management Kayali, Fatima Qutaishat, Sara Jubouri, Matti Chikhal, Rohan Tan, Sven Z. C. P. Bashir, Mohamad Front Cardiovasc Med Cardiovascular Medicine INTRODUCTION: Kinking of the Frozen Elephant Trunk (FET) stent graft is one of the most devastating complications of the FET procedure. It can present post-operatively with reduced arterial pressures in the lower limbs and intermittent claudication. However, it can also be visualized intra-operatively by the surgeons. Unresolved kinking of the stent graft can result in intraluminal thrombus formation and subsequent multi-organ septic emboli. AIMS: The main scope of this review is to collate, summarize and present all the evidence in the literature on kinking of FET stent grafts. METHODS: We carried out a comprehensive literature search on multiple electronic databases including PubMed, EMBASE, Ovid, and Scopus to collate all research evidence on the incidence, mechanism, and management of FET graft kinking. RESULTS: Incidence of kinking is variable, ranging from 0% to 8% in the literature, with varying rates associated with each stent graft type. The Thoraflex Hybrid(TM) prosthesis seemed to be the most commonly used and superior graft, and out of all the 15 cases of kinking reported in the literature, 5 (33.3%) were associated with just the Frozenix graft which had the highest incidence. There are multiple theories regarding the mechanism of kinking, including the direction of blood flow, the length of the stent grafts used, and the position of the prosthesis in relation to the flexure of the aorta. Multiple reparative management techniques have been suggested in the literature and include total endovascular repair, open repair, balloon dilatation, and deploying a second stent graft. CONCLUSION: Graft kinking is one of the most critical complications of the FET technique. Its life-threatening sequelae warrant appropriate follow-up of these patients post-operatively, in addition to time management if kinking is suspected. Given the limited evidence in the literature, future studies should incorporate graft kinking into their outcomes reporting. Frontiers Media S.A. 2022-04-27 /pmc/articles/PMC9091648/ /pubmed/35571190 http://dx.doi.org/10.3389/fcvm.2022.912071 Text en Copyright © 2022 Kayali, Qutaishat, Jubouri, Chikhal, Tan and Bashir. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Cardiovascular Medicine Kayali, Fatima Qutaishat, Sara Jubouri, Matti Chikhal, Rohan Tan, Sven Z. C. P. Bashir, Mohamad Kinking of Frozen Elephant Trunk Hybrid Prostheses: Incidence, Mechanism, and Management |
title | Kinking of Frozen Elephant Trunk Hybrid Prostheses: Incidence, Mechanism, and Management |
title_full | Kinking of Frozen Elephant Trunk Hybrid Prostheses: Incidence, Mechanism, and Management |
title_fullStr | Kinking of Frozen Elephant Trunk Hybrid Prostheses: Incidence, Mechanism, and Management |
title_full_unstemmed | Kinking of Frozen Elephant Trunk Hybrid Prostheses: Incidence, Mechanism, and Management |
title_short | Kinking of Frozen Elephant Trunk Hybrid Prostheses: Incidence, Mechanism, and Management |
title_sort | kinking of frozen elephant trunk hybrid prostheses: incidence, mechanism, and management |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9091648/ https://www.ncbi.nlm.nih.gov/pubmed/35571190 http://dx.doi.org/10.3389/fcvm.2022.912071 |
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