Stent graft kinking after total arch replacement using frozen elephant trunk with E-Vita open Neo

Stent graft kinking after total arch replacement with the frozen elephant trunk technique is a rare but potentially severe complication requiring prompt intervention when symptomatic. In the present case, the kinking was likely due to severe aortic arch angulation and fibrotic changes from prior surgeries. To reduce the risk of kinking in patients with significant aortic arch angulation, conventional total arch replacement or performing the distal anastomosis beyond the angulation should be considered during total arch replacement with the frozen elephant trunk procedure.