Endovascular Fenestration for Distal Aortic Sealing After Frozen Elephant Trunk With Thoraflex

Abstract

We describe a case of total arch replacement with frozen elephant trunk for chronic type B aortic dissecting aneurysm, which resulted in inadvertent landing of the frozen elephant trunk into the false lumen. A radiofrequency puncture system-assisted controlled endovascular fenestration of the dissection flap was performed at the upper abdominal aorta and subsequent thoracic endovascular stenting, successfully redirecting the blood flow from the false to the true lumen. Our case illustrated a possible way to seal distal reentry in chronic type B aortic dissection.

Aortic remodeling with frozen elephant trunk technique for Stanford type A aortic dissection using Japanese J-graft open stent graft

“…Paraplegia after the FET technique may be prevented by avoiding deep insertion of the stent graft in the descending aorta. Although some reports reported the possibility of new intimal tear caused by the open stent graft [10, 16, 24] placed in the aortic arch, no patient developed stent graft-induced new entry in our study patients. The very early result of FET is favorable to that of non-FET; however, the long-term result of FET may be favorable or may not be.…”

“…We aggressively opted for FET technique only when the entry was confirmed in the aortic arch during the operation, owing to concerns pertaining to inadvertent insertion of the device tip of the JOSG through the non-identified entry into the false lumen [16]. Therefore, in the non-FET group, we opted for traditional TAR without FET using step-wise technique.…”

Endovascular septal fenestration using a radiofrequency wire to salvage inadvertent false lumen deployment of a frozen elephant trunk stent graft

“…Another case with false lumen frozen elephant trunk used the NRG Transseptal Needle (Baylis Medical) to create a transseptal fenestration and pass a microwire into the false lumen, which was subsequently snared and pulled down to exit the opposite femoral artery creating a femoral-femoral through-wire. The through-wire was pulled down from both femoral access points, forcefully tearing the dissection septum, creating a new single common lumen, allowing endograft deployment into the previously placed elephant trunk 3 . This technique may create an aortic occlusion by pulling down the septal tissue to the aortic bifurcation and can potentially rupture the aorta.…”

“…This frozen elephant trunk deployment is often performed under gross examination of the dual lumens. Rarely, the endograft may inadvertently traverse a distal septal fenestration to end in the false lumen, pressurizing the false lumen and potentially resulting in devastating complications 2, 3. Urgent intervention is necessary when false lumen deployment results in downstream malperfusion.…”

Launching the E‐vita Open Neo amid COVID—Challenges and strategies

“…It has become one of the mainstream options with acceptable risk profiles 1–4 . It could offer a single‐stage treatment in selected arch aneurysm cases and, more importantly, it facilitates second‐stage treatments of descending pathologies with endovascular repair 1,2,5 and open replacement 1,2,6 …”