# Delayed visceral malperfusion caused by kinking of a four-branched integrated frozen elephant trunk graft

## TL;DR

A four-branched integrated frozen elephant trunk graft caused delayed complications due to kinking, leading to organ failure and limb ischemia, which were later corrected with a minimally invasive procedure.

## Contribution

Reports a novel complication of graft kinking with a newly available four-branched integrated frozen elephant trunk device.

## Key findings

- Postoperative graft kinking led to acute liver failure and kidney injury.
- Lower limb ischemia was also observed and corrected with thoracic endovascular aortic repair.
- The case highlights potential risks of the new four-branched graft design.

## Abstract

An integrated frozen elephant trunk with a four-branched vascular graft may shorten the circulatory arrest time during open distal anastomosis. We report a case of acute type A aortic dissection where postoperative graft kinking led to acute liver failure, kidney injury and lower limb ischaemia corrected by thoracic endovascular aortic repair.

In January 2023, the Frozenix 4 Branched (Japan Lifeline Co., Ltd, Tokyo, Japan) became commercially available.