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

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.