The frozen elephant trunk technique for the treatment of extensive thoracic aortic aneurysms: operative results and follow-up☆

Abstract

Objective: The 'frozen' elephant trunk technique allows for single-stage repair of combined aortic arch and descending aortic aneurysms using a 'hybridprosthesis' with a stented and a non-stented end. This report summarizes the operative-and follow-up data (mean follow-up 14 months) with this new treatment. Methods: Between 09/01 and 4/04, 22 patients (62G9 years; 9 female) with different aortic pathologies (15 aortic dissections, 7 aneurysms) were operated on after approval from the local institutional review board. The stented end of the hybridprosthesis was deployed in the descending aorta through the opened aortic arch during hypothermic circulatory arrest and selective antegrade cerebral perfusion. Results: All patients survived the procedure but one patient died of acute hemorrhage due to rupture of the false lumen in the descending aorta on the second postoperative day. Two patients required reexploration of the chest for bleeding complications. In 2 of 4 patients who developed neurological dysfunction, symptoms resolved completely. In one of them, the descending aorta was perforated intraoperatively due to misplacement of the stented end of the hybridprosthesis. In all follow-up CT-scans thrombus formation in the descending aortic aneurysm excluded by the stented end of the hybridprosthesis has been observed. Conclusions: This procedure is performed through median sternotomy and combines the concepts of the elephant trunk operation and endovascular stenting of descending aortic aneurysms. Favourable intraoperative and postoperative results during follow-up with regard to thrombus formation around the stented descending aortic segment encourage us to evaluate all patients with thoracic aneurysms extending to proximal and distal of the left subclavian artery for this treatment.Q 2005 Published by Elsevier B.V.

Endovascular repair of residual intimal tear or distal new entry after frozen elephant trunk for type A aortic dissection

“…With the advances in the surgical techniques and the availability of the FET prostheses, more and more centers, including ours, have adopted the FET and total arch replacement technique for patients with type A dissection. Evidence has been accumulating that the FET procedure can close the false lumen in the proximal descending aorta and reduce the need for reintervention on the downstream aorta (14)(15)(16)(17)(18)(19)(20). However, the FET technique may fail to achieve false lumen obliteration at the descending thoracic aorta level in 8-15% of patients (21,22).…”

History of reconstructive surgery of aorta and aortic valve

“…продемонс-трировали возможность применения гибридного про-теза дуги аорты, состоящего из стент-графта и не со-держащего стент сосудистого протеза для коррекции мегааорты [84]. Методика была названа frozen elephant trunk.…”

Radiopaque Ruler-Guided Frozen Elephant Trunk Technique

“…Antegrade delivery of a stent graft through a median sternotomy can treat extensive aortic lesions in a single stage. 1) When a FET is inserted into the descending thoracic aorta, it is very difficult to confirm its proper positioning. A shallower implantation than the target position is inadequate because it leads to type Ib endoleak.…”