Follow-up outcomes after the frozen elephant trunk technique in chronic type B dissection

Abstract

OBJECTIVES Our goal was to present our experience with a hybrid approach to the frozen elephant trunk (FET) technique for the treatment of patients with chronic type B aortic dissection. METHODS Between January 2013 and July 2019, 86 patients underwent the FET procedure at our centre. In 20 patients, the indication was chronic type B aortic dissection with a concomitant proximal aortic lesion. We evaluated the sites of proximal and distal entries, luminal communication and originating visceral branches in the computed tomography scan data. Primary end points were hospital deaths, complications and follow-up survival. Secondary end points included reintervention, thrombosis of the false lumen and aortic remodelling. RESULTS There were no deaths, neurological complications or paraplegia during hospitalization; however, a few patients (10%) had temporary acute renal failure or required secondary aortic reintervention during the follow-up period. We performed thoracic endovascular aortic repair with stable aortic remodelling during follow-up. The follow-up survival rate was 92.3%, and 87.5% of cases did not require aortic reintervention. CONCLUSIONS The FET technique is an effective method for treating chronic Stanford type B aortic dissection in patients at high risk of retrograde type A aortic dissection, concomitant disease of the proximal aorta and unsuitable anatomy for thoracic endovascular aortic repair, which allows for single-stage radical correction. Compared with thoracic endovascular aortic repair, the FET technique excludes the risk of type Ia endoleak, retrograde type A aortic dissection and possible stent graft migration. This technique provides comparable midterm follow-up outcomes and freedom from reintervention.

Early and Long-Term Follow-Up for Chronic Type B and Type Non-A Non-B Aortic Dissection Using the Frozen Elephant Trunk Technique

“…The early and long-term results of this technique for patients with chronic type B or non-A non-B AD were acceptable, which indicates that the FET procedure is a safe and effective approach for such patients. The competing analysis showed that the need for distal aortic reintervention was 13.0% at 7 years, which was comparable with the result reported by Charchyan et al ( 20 ). The authors showed that the cumulative incidence rates of aortic reintervention were 5.6% at 0.5 years and 11.1% at 4 years.…”

“…We recommend that the FET procedure be performed if the patients have type B or non-A non-B AD concomitant with the following conditions ( 20 ): (i) aortic root or ascending aorta aneurysm; (ii) left common carotid artery dissection involvement or aortic arch aneurysm; (iii) proximal aortic lesion with coronary artery disease or aortic valve disease; (iv) contraindication for TEVAR; and (v) a high risk of RTAAD. The FET procedure for treating type B or non-A non-B AD unfit for TEVAR has some advantages ( 21 ).…”

A case report of a hybrid procedure (visceral and partial aortic arch debranching) in the treatment of a challenging aneurysm of the thoracoabdominal aorta in the endovascular era

“…In selected cases of difficult aortic arch anatomy and risk for retrograde type A dissection after TEVAR, a frozen elephant trunk can be an alternative method for arch repair [29]. Sometimes, when the aortoiliac segment is not suitable for inflow, antegrade visceral debranching from the ascending aorta might be performed [30].…”

Frozen elephant trunk in total arch replacement: A systematic review and meta‐analysis of outcomes and aortic proximalization

“…Of 64 studies reporting outcomes of patients included in this report 13–76 . The proportions of studies from Asia, Europe, and North America were 54.7%, 31.3%, and 10.9%, respectively.…”