Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Mar 10:9:875078.
doi: 10.3389/fcvm.2022.875078. eCollection 2022.

Incidence of Distal Stent Graft Induced New Entry vs. Aortic Remodeling Associated With Frozen Elephant Trunk

Matti Jubouri  1 , Fatima Kayali  2 , Priyanshu Saha  3 , Daniyal M Ansari  3 , Yousef Rezaei  4 , Sven Z C P Tan  5 , Mostafa Mousavizadeh  4 , Saeid Hosseini  4 , Idhrees Mohammed  6 , Mohamad Bashir  7
Affiliations
Review

Incidence of Distal Stent Graft Induced New Entry vs. Aortic Remodeling Associated With Frozen Elephant Trunk

Matti Jubouri et al. Front Cardiovasc Med. .

Abstract

Background: The introduction of the frozen elephant trunk (FET) technique for total arch replacement (TAR) has revolutionized the field of aortivascular surgery by allowing hybrid repair of complex aortic pathologies in a single step through combining an open surgical approach with an endovascular one. FET has been associated with favorable aortic remodeling, however, its is also associated with development of distal stent graft induced new entry (dSINE) tears postoperatively. The rate of aortic remodeling and the incidence of dSINE have been linked together, in addition, there seems to be a relationship between these two variables and FET insetion length as well as graft size.

Aims: The scope of this review is to highlight the rate of aortic remodeling as well the incidence of dSINE associated with different FET devices available commercially. This review also aimed to investigate the relationship between aortic remodeling, dSINE, FET insertion length and FET graft size.

Methods: We conducted a comprehensive literature search using multiple electronic databases including PubMed, Ovid, Scopus and Embase in order to collate all research evidence on the above mentioned variables.

Results: Thoraflex™ Hybrid Plexus seems to yield optimum aortic remodeling by promoting maximum false thrombosis as well true lumen expansion. Thoraflex Hybrid™ is also associated with the lowest incidence of dSINE post-FET relative to the other FET devices on the market. Aortic remodeling and dSINE do influence each other and are both linked with FET graft length and size.

Conclusion: The FET technique for TAR shows excellent aortic remodeling but is associated with a considerable risk of dSINE development. However, Thoraflex™ Hybrid has demonstrated itself to be the superior FET device on the aortic arch prostheses market. Since aortic remodeling, dSINE, FET insertion length and stent graft size are all interconnect, the choice of FET device length and size must be made with great care for optimum results.

Keywords: aortic aneurysm; aortic dissection; aortic surgery; frozen elephant trunk; total arch replacement.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

    1. Di Marco L, Murana G, Fiorentino M, Amodio C, Mariani C, Leone A, et al. . The frozen elephant trunk surgery: a systematic review analysis. Indian J Thorac Cardiovasc Surg. (2019) 35:118–26. 10.1007/s12055-019-00815-0 - DOI - PMC - PubMed
    1. Karck M, Chavan A, Hagl C, Friedrich H, Galanski M, Haverich A. The frozen elephant trunk technique: A new treatment for thoracic aortic aneurysms. J Thorac Cardiovasc Surg. (2003) 125:1550–3. 10.1016/S0022-5223(03)00045-X - DOI - PubMed
    1. Tochii M, Takami Y, Ishikawa H, Ishida M, Higuchi Y, Sakurai Y, et al. . Aortic remodeling with frozen elephant trunk technique for Stanford type A aortic dissection using Japanese J-graft open stent graft. Heart Vessels. (2019) 34:307–15. 10.1007/s00380-018-1246-x - DOI - PMC - PubMed
    1. Roselli EE, Idrees JJ, Bakaeen FG, Tong MZ, Soltesz EG, Mick S, et al. . Evolution of Simplified Frozen Elephant Trunk Repair for Acute DeBakey Type I Dissection: Midterm Outcomes. Ann Thorac Surg. (2018) 105:749–55. 10.1016/j.athoracsur.2017.08.037 - DOI - PubMed
    1. Watanabe Y, Shimamura K, Yoshida T, Daimon T, Shirakawa Y, Torikai K, et al. . Aortic remodeling as a prognostic factor for late aortic events after thoracic endovascular aortic repair in type B aortic dissection with patent false lumen. J Endovasc Ther. (2014) 21:517–25. 10.1583/13-4646R.1 - DOI - PubMed

LinkOut - more resources