True-lumen and false-lumen diameter changes in the downstream aorta after frozen elephant trunk implantation

Abstract

The frozen elephant trunk technique is associated with an excellent clinical outcome in a complex cohort of patients, and also effectively induces remodelling in downstream aortic segments in acute and chronic thoracic aortic dissections. The need for secondary interventions in downstream segments, which mainly depends on the extent of the underlying disease process, remains substantial. Further studies are required to assess the long-term outcome of this approach.

Long Stent Graft for Frozen Elephant Trunk Repair in Acute Type A Aortic Dissection

“…Postoperative dilatation of the distal aorta is the major factor that threatens the survival of patients. As mentioned in other literature [13,19], in the thoracic segment, the TL increased, the FL decreased, and the total diameter remained stable compared with pre-operation, while in the abdominal segment, the TL remained stable, the FL and AL diameter increased gradually. In our series, the results in both the long FET and short FET groups were similar to those mentioned above.…”

Non‐A non‐B aortic dissection: A literature review

“…FET is also recognized in the literature to promote favorable remodeling in the distal aorta 50,51 . Another advantage of FET is no type I endoleak as well as its ability to establish a highly stable proximal landing zone for the eventual stent graft implantation in the descending thoracic aorta 50,52,53 . However, the main limitation associated with FET is the increased surgical trauma secondary to the necessarily prolonged periods of extracorporeal circulation, circulatory arrest as well as myocardial ischemia 11 .…”

The frozen elephant trunk technique in acute and chronic aortic dissection: intraoperative setting and patient selection are key to success

“…In scenarios where the primary entry tear is located more distally in the aortic arch or proximal descending aorta, which is often associated with a narrow true lumen or even total true lumen collapse resulting in visceral and/or renal malperfusion, surgery that is limited to the ascending aorta may prevent early aortic rupture but leaves the underlying disease mechanism unaddressed. In these cases, the FET technique addresses closure of the primary entry tear as well as expanding the narrow true lumen of the entire aorta to abdominal aortic segments in a domino-type effect (1).…”

“…The use of cerebrospinal fluid drainage is not routinely required, as spinal cord injury could be effectively reduced to a minimum by using prostheses with the shortest available stented part and by performing distal extension as a second-stage procedure. This is in consideration of the fact that the number of simultaneously occluded segmental arteries is only one contributing factor of spinal cord injury (1). Cannulation of the right subclavian artery for arterial return can be performed safely in acute as well as chronic aortic diseases.…”