Covered frozen elephant trunk technique for prevention of distal stent graft-induced new entry

Abstract

Distal stent graft-induced new entry is not rare after frozen elephant trunk implantation. We report a case of covered frozen elephant trunk placement for prevention of distal stent graft-induced new entry. Coverage of the rigid distal stent edge using a graft reduces mechanical stress on the intima and radial force of the distal stent; therefore, this technique can potentially prevent distal stent graft-induced new entry.

Fenestrated and covered frozen elephant trunk technique for management of chronic aortic dissection

“…Coverage of a rigid FET using a soft graft may at least partially reduce the radial force and prevent d‐SINE. The covered FET technique reportedly reduced radial force at the distal edge of the FET 2 …”

“…To address this issue in our patient, the distal edge of the FET was covered using a piece of a soft graft before deployment.Coverage of a rigid FET using a soft graft may at least partially reduce the radial force and prevent d-SINE. The covered FET technique reportedly reduced radial force at the distal edge of the FET 2. The proximal descending aorta was enlarged in our patient; therefore, we performed Zone 2 distal anastomosis with a fenestrated FET technique to perfuse the LSCA via the fenestration in the FET 3.…”

“…After establishing cardiopulmonary bypass, the distal edge of the FET (J Graft FROZENIX; Japan Lifeline) was modified to reduce the mechanical stress and radial force of the FET (Figure 2A). 2 Briefly, the distal edge of the FET was partially unfolded within the excised graft (2 cm in length). After the FET and excised graft were | 5487 sutured, the modified FET was manually compressed using tourniquets (Supplementary Information: Video 1).…”

“…Therefore, theoretically, coverage of the distal edge of the FET may at least partially reduce the radial force, effectively reduce intimal stress, and prevent d-SINE. 2 Regarding supra-aortic vessel reconstruction, creation of a fenestration on the FET enables antegrade blood flow into one or more supra-aortic vessels and eliminates the need to reconstruct these vessels. 3 We report a case of successful redo arch repair using the fenestrated and covered FET technique for chronic residual aortic dissection.…”

“…Mechanical stress on the intima at the distal edge of the FET is a known contributor to d‐SINE. Therefore, theoretically, coverage of the distal edge of the FET may at least partially reduce the radial force, effectively reduce intimal stress, and prevent d‐SINE 2 . Regarding supra‐aortic vessel reconstruction, creation of a fenestration on the FET enables antegrade blood flow into one or more supra‐aortic vessels and eliminates the need to reconstruct these vessels 3 .…”