The FET technique provides an effective treatment for AoD, promoting FL thrombosis and remodelling in the descending thoracic aorta. Changes in the diameter of the aortic lumen depend mainly on the status of the FL and are similar between acute and chronic AoD. Changes in the diameter of true lumen are affected by both the FL status and the timing of the presentation. However, increased FL thrombosis and positive remodelling rates are not maintained at the level of the abdominal aorta, and strict follow-up is mandatory to detect early changes in the aortic dimensions, which may warrant further interventions.

No abstract

Background: Over the years, frozen elephant trunk (FET) has become the treatment of choice for multisegmental thoracic aortic disease. This multicenter study presents the evolution of FET results using the E-vita Open hybrid graft with respect to institutional experience and time. Methods: The data of International E-vita Open registry were studied according to the institutional experience of the participating centers (high-versus low-volume centers) and according to the evolution of FET treatment during time (1 st period, 2005-2011 versus 2 nd period, 2012-2018). Overall, 1,165 patients were enrolled in the study with a wide variety of multisegmental thoracic aortic pathologies and aortic emergencies. Participating centers determined their own surgical protocol. Results: The overall 30-day mortality was 12%. Short-and long-term survival were higher in high-versus low-volume centers (P=0.048 and P=0.013, respectively). In the 2 nd time period, cerebral complications were reduced significantly (P=0.015). Incidence of permanent spinal cord-related symptoms was reduced to 3% in the 2 nd time period, but did not reach statistical significance. Hypothermic circulatory arrest time (P<0.001) and incidence of postoperative temporary renal replacement therapy (P=0.008) were significantly reduced in the 2 nd time period. Ten-year survival and freedom from aortic-related death rates were 46.6% and 85.7%, respectively, for the entire group. The freedom from distal aortic re-interventions for a new or progressive residual aortic disease was 76.0%. Conclusions: Evolution of FET arch repair techniques with the E-vita Open graft and increasing institutional experience were associated with improved results. Progression of residual aortic disease makes close follow-up with aortic imaging mandatory in such patients.

We report the case of a 51-year-old man with massive haemoptysis due to a systemic arterialization of lung without sequestration. Unlike bronchopulmonary sequestration there was a normal bronchial distribution and the involved lung parenchyma was normal. Therefore a therapeutic transarterial embolization of the aberrant systemic vessel from the distal thoracic aorta was performed. The embolization was successful and the patient did not suffer from further haemoptysis during the subsequent follow-up of ten months. A postembolization aortogram 6 months later demonstrated a complete occlusion of the embolized aberrant artery; in the lung perfusion scan there was only a small perfusion defect, but normal ventilation in the embolized basal part of the left lower lobe. Our case represents an alternative treatment to surgery for this rare anomaly.

Hybrid aortic repair using the FET in acute DeBakey type I aortic dissection does not elevate the perioperative risk of mortality and provides excellent aortic remodelling with low distal re-intervention rate in mid-term follow-up.