“…For this reason, several groups have advocated the use of more aggressive primary operations in TAAD patients, including total arch replacement with or without elephant trunk construction [2,3] or, more recently, using the frozen elephant trunk technique [17][18][19]. Compared with CAM, TAR with classic or frozen elephant trunks may also facilitate and improve outcomes after secondary distal endovascular or open surgical interventions [20][21][22]. However, while some studies have reported a reduced patent false lumen incidence to almost 25% in patients undergoing TAR [20][21][22] and a recent review has shown that aortic remodeling is highly expected after TAR plus FET, as indicated by an 88.9% averaged rate of partial or complete thrombosis of the peri-stent false lumen [8], other studies have shown stable dissection evolutions with very low growth rates independent of the status of false lumen at the descending thoracic aorta, and with low rates of distal reinterventions at 10 years (<16%) [5,22,23].…”