Hybrid Repair for Ruptured Thoracic Aortic Aneurysm: Frozen Elephant Trunk Technique with Thoracic Endovascular Aortic Repair

Abstract

We present a case of ruptured thoracic aortic aneurysm (TAA) with type B aortic dissection in which hybrid repair, namely, the frozen elephant trunk (FET) technique with thoracic endovascular aortic repair (TEVAR), was performed. The TAA extended to the proximal descending aorta at the level of the pulmonary trunk bifurcation. We thus employed the FET technique to control the blood flow into the TAA. After performing the FET technique, intraoperative catheter aortography revealed slight type 1B endoleak. We therefore performed additional TEVAR to control the blood flow into the TAA. The patient's postoperative course was uneventful.

Keywords: aortic dissection; frozen elephant trunk.

Fig. 1 Preoperative enhanced CT, large pericardial effusion (A), mediastinal hematoma, 60 mm of the TAA at the aortic arch and type B aortic dissection with patent false lumen in which the entry tear was located in distal site of the TAA (B: ※). LCCA: left common carotid artery; LSCA: left subclavian artery

Fig. 2 The intraoperative aortography showed type 1B endoleak slightly and no retrograde false lumen flow (A: arrow). Endoleak disappeared after deployment of the stent graft (B).

Fig. 3 Postoperative enhanced CT showed well shield of the aneurysm (B: ), expansion of the true lumen, and complete thrombosis of the false lumen (C).