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External Stenting (Exostenting) to Correct Vascular Torsion and AngulationFunding None.
Organ transplantation can be associated with vascular torsions and angulations of both recipient and donor vessels. Such kinks and/or torsions of vessels can compromise the vascular integrity, obstruct inflow and/or outflow, and result in loss of the organ and/or body parts. On many occasions, mild angulations and torsions can be successfully addressed by repositioning the organ. In cases where the abnormal findings persist, maneuvers such as placing a fat pad to create a smoother curve, or even opening the peritoneum (in the case of kidney transplants) to allow for a better positioning of the organ, are associated with successful outcomes. When such torsions/angulations persist despite these approaches, further innovative tactics are required. In the current report, we propose a technique that involves longitudinally opening of a synthetic graft that is rigid enough to maintain its shape, such as a ringed polytetrafluoroethylene graft, and placing it as an external stent around the angulated/torsioned vessel. This maneuver will correct the underlying vascular compromise without having to perform any further invasive interventions, such as reimplanting the organ or resecting part of the involved vessel. Although primarily illustrated for application by describing an instance in which exostenting was applied during kidney transplantation, our approach could be applied to any vessel under many circumstances where angulations/twists are encountered. In this report, we describe the use of an external stent, also called exostenting, to correct a severe torsion/angulation of the external iliac artery in a kidney transplant recipient where all other measures were unsuccessful.
Keywordsvascular - torsion - vessel - tortuosity - external stenting - exostenting - support - organ compromise - transplant - kidney
+ These authors have equal contribution
Article published online:
23 May 2021
© 2021. International College of Angiology. This article is published by Thieme.
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- 1 Schep G, Kaandorp DW, Bender MH, Weerdenburg H, van Engeland S, Wijn PF. Magnetic resonance angiography used to detect kinking in the iliac arteries in endurance athletes with claudication. Physiol Meas 2001; 22 (03) 475-487
- 2 Helisch A, Schaper W. Arteriogenesis: The development and growth of collateral arteries. Microcirculation 2003; 10 (01) 83-97
- 3 Del Corso L, Moruzzo D, Conte B. et al. Tortuosity, kinking, and coiling of the carotid artery: Expression of atherosclerosis or aging?. Angiology 1998; 49 (05) 361-371
- 4 Owen CG, Newsom RS, Rudnicka AR, Barman SA, Woodward EG, Ellis TJ. Diabetes and the tortuosity of vessels of the bulbar conjunctiva. Ophthalmology 2008; 115 (06) e27-e32
- 5 Pries AR, Secomb TW. Structural adaptation of microvascular networks and development of hypertension. Microcirculation 2002; 9 (04) 305-314
- 6 Han HC. Twisted blood vessels: Symptoms, etiology and biomechanical mechanisms. J Vasc Res 2012; 49 (03) 185-197
- 7 Camiade C, Maher A, Ricco JB. et al. Carotid bypass with polytetrafluoroethylene grafts: A study of 110 consecutive patients [Published correction appears in J Vasc Surg 2004 Jan;39(1):188]. J Vasc Surg 2003; 38 (05) 1031-1037 , discussion 1038
- 8 Dobrin PB, Hodgett D, Canfield T, Mrkvicka R. Mechanical determinants of graft kinking. Ann Vasc Surg 2001; 15 (03) 343-349
- 9 Han HC, Zhao L, Huang M, Hou LS, Huang YT, Kuang ZB. Postsurgical changes of the opening angle of canine autogenous vein graft. J Biomech Eng 1998; 120 (02) 211-216
- 10 Grego F, Lepidi S, Cognolato D, Frigatti P, Morelli I, Deriu GP. Rationale of the surgical treatment of carotid kinking. J Cardiovasc Surg (Torino) 2003; 44 (01) 79-85
- 11 Illuminati G, Calió FG, Papaspyropoulos V, Montesano G, D'Urso A. Revascularization of the internal carotid artery for isolated, stenotic, and symptomatic kinking. Arch Surg 2003; 138 (02) 192-197
- 12 Taggart DP, Amin S, Djordjevic J. et al. A prospective study of external stenting of saphenous vein grafts to the right coronary artery: The VEST II study. Eur J Cardiothorac Surg 2017; 51 (05) 952-958
- 13 Korkes F, Silveira M, Neves-Neto OC. et al. Nutcracker syndrome: Laparoscopic external stenting of the renal vein (“the shield technique”). Int Braz J Urol 2017; 43 (02) 373
- 14 Angelini GD, Izzat MB, Bryan AJ, Newby AC. External stenting reduces wall thickening in arteriovenous bypass grafts. J Thorac Cardiovasc Surg 1996; 112 (01) 79-84
- 15 Mehta D, George SJ, Jeremy JY. et al. External stenting reduces long-term medial and neointimal thickening and platelet derived growth factor expression in a pig model of arteriovenous bypass grafting. Nat Med 1998; 4 (02) 235-239