Complex thoracic aortic disease: Single-stage procedure with the frozen elephant trunk technique

Abstract

In contrast to the conventional elephant trunk technique, the frozen elephant trunk technique offers a potentially curative single-stage procedure for patients with extensive thoracic aortic disease, with encouraging short-term and midterm results.

Combined Frozen Elephant Trunk and Endovascular Repair for Extensive Thoracic Aortic Aneurysms

“…Very few cases have been treated with this complex technique; therefore, great caution should be use in the interpretation of clinical results .It is still to be ascertained whether the risks associated with this single-stage procedure may be considered inferior to the cumulative risks of the established two-step approach. In such setting, major series have reported that the rate of failure to complete the second step may range between 32% and 60% [1,7].…”

“…The use of the hybrid endoprosthesis and the frozen elephant trunk procedure (FET) is reliable for the single-stage treatment of thoracic aortic disease extending to the descending segment [1]. Although its efficacy in avoiding second-stage surgery is most documented in the setting of acute and chronic dissection, still a second-stage endovascular or surgical completion may be needed after FET whenever the distal extension of aortic pathology exceeds the length of the stent-graft portion of the hybrid endoprosthesis [2].…”

“…This may be required in a proportion of cases which is still scarcely understood, but most frequently in the instance of aneurysm of the entire descending aorta. The waiting time between the FET procedure and the endovascular completion is associated with an incidence of aortic-related adverse events and mortality [1,3]. Thus, the achievement within one procedure of complete repair of extensive arch and descending aortic aneurysm could be advisable in selected cases.…”

Open repair techniques in the aortic arch are still superior

“…In particular the false lumen in the descending aorta thromboses in a large proportion of patients, reducing the risk for further late distal malperfusion syndromes. Several groups have, indeed, published quite satisfactory results with the use of this method, in particular after surgery for acute or chronic aortic dissection (43)(44)(45)(46).…”

Surgical Management of the Aortic Root

“…[115] With the elephant trunk procedure, the latest and best survival data are from Italy. [116] In 2010, Bartolomeo et al published their series of 67 patients who underwent the frozen elephant trunk over a two year period. Peri-operative mortality was 13.4%.…”