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. 2021 Oct 12;57(10):1090.
doi: 10.3390/medicina57101090.

Frozen Elephant Trunk in Aortic Arch Disease: Different Devices for Different Pathologies

Carlo Mariani  1   2 , Giacomo Murana  1 , Alessandro Leone  1 , Luca Di Marco  1 , Davide Pacini  1   2
Affiliations

Frozen Elephant Trunk in Aortic Arch Disease: Different Devices for Different Pathologies

Carlo Mariani et al. Medicina (Kaunas). .

Abstract

The frozen elephant trunk technique (FET) requires the use of a pre-assembled hybrid prosthesis consisting of a standard Dacron vascular portion to replace the aortic arch and a stent graft component, which is placed into the proximal descending thoracic aorta (DTA) anterogradely in the proximal descending thoracic aorta. In Europe, two hybrid prostheses are available: the E-evita Open Plus hybrid stent graft system provided by JOTEC (Hechingen, Germany) and the ThoraflexTM Hybrid (Vascutek, Inchinnan Scotland). Recommendations for use are extensive pathologies of the arch in case of acute and chronic aortic dissection, degenerative aneurysm and intramural hematoma. The FET approach allows the replacement of the whole arch in one stage with the option of direct treatment of the proximal descending thoracic aorta based on the stent component, creating a safe landing zone for further endovascular treatment more distally. The remarkable feature of this technique is the possibility to perform more proximally (from zone 3 to zone 0) the distal anastomosis in to the arch. This allows for an easier distal anastomosis, reduced hypothermic circulatory arrest time and decreased risk of paraplegia (<5%). Early results are promising and according to the most recent series the rate of developing post-operative renal insufficiency ranges from 3 to 10%, the risk of stroke from 3% to 8% and mortality from 8-15%. The aim of the article will be to provide some knowledge about the use and application of FET procedures in different aortic situations.

Keywords: aortic aneurysm; aortic dissection; frozen elephant trunk.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A). Chronic residual aortic dissection, (B) post-operative CT scan, (C) post-operative CT scan reconstruction.
Figure 2
Figure 2
(A). Degenerative aneurism of the descending thoracic aorta, (B). Post FET CT scan.
Figure 3
Figure 3
Dimension of the stent graft (mm).
See this image and copyright information in PMC

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