Imaging description

Prosthetic aortic grafts often have areas of kinking where there is in-folding of the graft wall into the aortic lumen. This is a normal post-operative finding that is generally of no clinical consequence. On axial images, vertically oriented folds will have the appearance of an intraluminal flap and can mimic dissection (Figures 70.1 and 70.2). Inspection of sagittal and coronal planes and volume-rendered images will allow visualization of the kinked segment and exclusion of dissection.

Importance

It is important to avoid misdiagnosis of aortic dissection as it may lead to unnecessary surgery or repeat imaging.

Typical clinical scenario

Kinking in the aortic graft is common in patients with prior open graft repair of the thoracic or abdominal aorta.

Differential diagnosis

Aortic graft kinking should be distinguished from a true aortic dissection. Careful inspection of multiplanar and 3D reformatted images should allow visualization of the kinking and prevent misdiagnosis. The location of abnormality can also be helpful as dissections do not occur within prosthetic aortic graft material. Dissections may, however, occur in the native aorta immediately adjacent to an anastomosis.

Teaching point

Kinking of aortic grafts after open aortic repair is common and can result in linear intraluminal filling defects that mimic dissection on axial images. The use of multiplanar reformatted and volume-rendered images will allow visualization of the kinked segment and help avoid misdiagnosis.