The frozen elephant trunk technique for aortic dissection is safe after previous aortic repair

2020 ◽  
Vol 59 (1) ◽  
pp. 130-136
Author(s):  
Tim Berger ◽  
Maximilian Kreibich ◽  
Felix Mueller ◽  
Bartosz Rylski ◽  
Stoyan Kondov ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Aortic Surgery ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Aortic Arch Replacement ◽  
Mortality And Morbidity ◽  
Aortic Repair ◽  
Aortic Replacement ◽  
Aortic Interventions

Abstract OBJECTIVES The goal of this study was to evaluate outcomes of aortic arch replacement using the frozen elephant trunk (FET) technique after previous proximal and/or distal open or endovascular thoracic aortic repair. METHODS Sixty-three patients [median age: 63 (55–74) years; 65% men] were operated on for acute or chronic aortic dissection after previous proximal and/or distal open or endovascular thoracic aortic repair. Intraoperative details, clinical outcome and follow-up results were evaluated. RESULTS The median time between the index and the FET procedure was 81 (40–113) months. Fifty-eight (92%) patients had already undergone proximal aortic surgery; supracoronary ascending aortic replacement was the most frequent index procedure [n = 25 (40%)]. Distal aortic interventions had been done in 8 (13%) patients including endovascular thoracic aortic repair in 6 patients (10%). In-hospital mortality was 3% (n = 2). Postoperative strokes occurred in 5 patients (8%); of those, 1 stroke was dissection-related (2%). Subsequent aortic reinterventions after the FET procedure had to be done in 33% (n = 21). CONCLUSIONS Outcomes of aortic arch replacement using the FET technique after previous proximal and/or distal open or endovascular thoracic aortic repair are associated with low mortality and morbidity. Still, postoperative stroke remains an issue. After the successful accomplishments, the approach serves as an ideal platform for the secondary surgical or endovascular downstream aortic procedures, which are frequently needed.

Simplified Elephant Trunk Graft Technique for Aortic Arch Replacement

2002 ◽  
Vol 10 (4) ◽  
pp. 374-375 ◽  
Author(s):  
Shinji Miyamoto ◽  
Tetsuo Hadama ◽  
Hirofumi Anai ◽  
Hidenori Sako ◽  
Tomoyuki Wada ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Aortic Arch ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Distal Anastomosis ◽  
Elephant Trunk ◽  
Aortic Arch Replacement ◽  
Aortic Replacement

We refined the elephant trunk graft to facilitate and reinforce the distal anastomosis in aortic replacement operations. A cuff is created in a single four-branch graft, which is used for the distal anastomosis; the trunk below the cuff is inserted into the distal aortic stump. This method is feasible for repairing extensive aortic aneurysm with a fragile wall and for treating acute aortic dissection where thromboocclusion of the remaining false lumen is desired.

scholarly journals Krónikus aortadissectio talaján kialakult thoracoabdominalis aneurysma endovascularis kezelése fenesztrált sztentgrafttal

2021 ◽  
Vol 162 (31) ◽  
pp. 1260-1264
Author(s):  
Csaba Csobay-Novák ◽  
László Entz ◽  
Péter Banga ◽  
Miklós Pólos ◽  
Zoltán Szabolcs ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Open Repair ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Advanced Technology ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Aorta Ascendens ◽  
Mortality And Morbidity ◽  
Aortic Repair

Összefoglaló. Az aortadissectio krónikus stádiumában kialakuló thoracoabdominalis tágulatok megoldása multidiszciplináris megközelítést, nagy felkészültséget és fejlett technológiát igényel. A jellemzően többlépcsős műtétsorozat mortalitása és morbiditása az endovascularis technológia fejlődésével csökkent, de még mindig jelentős. A fenesztrált endovascularis aortaműtét a thoracoabdominalis nyitott műtét alternatívája, mely kisebb mortalitással és morbiditással, rövidebb kórházi tartózkodással jár. Aortadissectio esetén történő alkalmazása az aorta lumenében lévő membrán miatt kihívást jelent. Esetbemutatásunkban egy 56 éves nőbeteget demonstrálunk, aki tíz évvel korábban A-típusú dissectio miatt aorta ascendens rekonstrukción esett át. A követés során csaknem a teljes aorta tágulata alakult ki, melynek megoldása három lépésben történt. Az első lépésben a disszekált aortaív nyitott műtétjét végeztük ’frozen elephant trunk’ technikával, majd az aorta descendens tágulatának endovascularis kezelése történt sztentgraft-implantációval. A műtétsorozat záró lépése egy fenesztrált endovascularis aortaműtét volt, mely egyben ezen technikának az aortadissectio esetében történt első hazai alkalmazását jelenti. Orv Hetil. 2021; 162(31): 1260–1264. Summary. Thoracoabdominal aortic aneurysms developing in the chronic phase of an aortic dissection require multidisciplinary approach, experienced operators and advanced technology. The mortality and morbidity rate of these multistage operations were reduced with the latest technical achievements in endovascular repair, but they are still significant. Fenestrated endovascular aortic repair, an alternative of thoracoabdominal open repair, is associated with less mortality and morbidity, shorter hospital stay. Using fenestrated devices in aortic dissection is usually technically demanding due to the dissection membrane. We report the case of a 56-year-old woman, who underwent ascending aortic repair due to type A aortic dissection. During the follow-up, a large thoracoabdominal aneurysm developed involving also the arch. We performed a three-stage operation starting with the open repair of the aortic arch using a ‘frozen elephant trunk’ device followed by a thoracic endovascular aortic repair of the descending aorta. The final stage was a fenestrated endovascular aortic repair, which is the first use of this technique in aortic dissection in Hungary. Orv Hetil. 2021; 162(31): 1260–1264.

Total Aortic Arch Replacement and Frozen Elephant Trunk

2020 ◽  
Author(s):  
Jacky Y.K. Ho ◽  
Simon C.Y. Chow ◽  
Micky W.T. Kwok ◽  
Takuya Fujikawa ◽  
Randolph H.L. Wong
Keyword(s):  
Aortic Arch ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Aortic Arch Replacement ◽  
Total Aortic Arch Replacement
Sign in / Sign up

Export Citation Format

Share Document