scholarly journals Simple endovascular thoracic aortic stenting rescues a wrongly deployed frozen elephant trunk during a modified procedure

2021 ◽  
Vol 49 (2) ◽  
pp. 030006052098671
Author(s):  
Gregory Reid ◽  
Constantin Mork ◽  
Edin Mujagic ◽  
Denis Berdajs
Keyword(s):  
Computed Tomography ◽  
Thoracic Aorta ◽  
Computed Tomography Angiography ◽  
False Lumen ◽  
Distal Segment ◽  
Type I ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Aortic Stenting ◽  
Elephant Trunk Procedure

We report a bail out approach of endovascular thoracic aorta repair following incorrect deployment of a modified frozen elephant trunk stent graft into the false lumen. A 76-year-old patient was admitted to our Emergency Department. A computed tomography angiography scan showed type I DeBakey aortic dissection. An emergency modified frozen elephant trunk procedure was performed. Immediate postoperative computed tomography angiography showed that the distal segment of the stent was deployed in the false lumen, probably through a re-entry tear at the descending thoracic aorta. Emergency endovascular repair of the thoracic aorta, as well as angioplasty of the superior mesenteric artery and left iliac artery, were performed.

scholarly journals Thoraflex hybrid as frozen elephant trunk in chronic, residual type A and chronic type B aortic dissection

2020 ◽  
Author(s):  
Mariafrancesca Fiorentino ◽  
Hector W L de Beaufort ◽  
Uday Sonker ◽  
Robin H Heijmen
Keyword(s):  
Thoracic Aorta ◽  
False Lumen ◽  
Frozen Elephant Trunk ◽  
True Lumen ◽  
Elephant Trunk ◽  
Stroke Incidence ◽  
The Status ◽  
Elephant Trunk Technique ◽  
Complete Thrombosis ◽  
Aortic Dissections

Abstract OBJECTIVES The frozen elephant trunk technique is an increasingly common treatment for extensive disease of the thoracic aorta. The objective of the study was to evaluate the outcomes of frozen elephant trunk specifically in chronic (residual) aortic dissections, focusing on downstream aortic remodelling. METHODS Between 2013 and 2019, a total of 28 patients were treated using the Vascutek Thoraflex hybrid graft at our institution for chronic dissections/post-dissection aneurysms. Immediate and follow-up outcomes were studied, as well as the changes in total aortic diameter, true lumen and false lumen diameter and the status of the false lumen at 3 different levels of the thoraco-abdominal aorta. RESULTS No in-hospital or 30-day mortality was observed, temporary paraparesis rate was 7% and disabling stroke incidence was 14.3%. Freedom from all-cause mortality at 2 years was 91.6 ± 5.7%, while freedom from reintervention on the downstream aorta at 2 years was 59.1 ± 10.8%. Positive aortic remodelling was achieved in 50.0%, with an enlargement in the true lumen and a reduction of the false lumen not only at the level of the proximal descending aorta with 73.1% of complete thrombosis but also at the level of the distal descending thoracic aorta, with 41.7% of complete thrombosis. CONCLUSIONS The frozen elephant trunk is a good solution in chronic (residual) downstream aortic dissections inducing positive aortic remodelling and preventing from II stage operations or allowing an endovascular approach.

scholarly journals Bail-out thoracic endovascular aortic repair for incorrect deployment of frozen elephant trunk into the false lumen

2020 ◽  
Vol 30 (6) ◽  
pp. 947-949
Author(s):  
Motoharu Kawashima ◽  
Yoshikatsu Nomura ◽  
Masamichi Matsumori ◽  
Hirohisa Murakami
Keyword(s):  
Computed Tomography ◽  
False Lumen ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Aortic Repair ◽  
Enhanced Computed Tomography ◽  
Bail Out

Abstract We report a rare case of bail-out thoracic endovascular aortic repair after incorrect deployment of a frozen elephant trunk into the false lumen. A 54-year-old man presented to our department complaining of chest pain. Enhanced computed tomography revealed Stanford type A acute aortic dissection, which had a large entry site at the mid-descending aorta. Emergency total aortic arch replacement with a frozen elephant trunk was performed. Progressive intraoperative acidosis was observed. Immediate postoperative enhanced computed tomography showed that the distal end of the frozen elephant trunk was deployed into the false lumen through the initial tear at the proximal descending aorta. We performed emergency thoracic endovascular aortic repair through a fenestration made into the intimal flap using an Outback LTD re-entry device. The patient was discharged home on postoperative day 67 after a complete recovery.

scholarly journals Endovascular fenestration of aortic dissection membrane after failed frozen elephant trunk procedure

2019 ◽  
Author(s):  
Jan Raupach ◽  
Vendelin Chovanec ◽  
Veronika Kozakova ◽  
Jan Vojacek
Keyword(s):  
Aortic Dissection ◽  
False Lumen ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
True Lumen ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique ◽  
Elephant Trunk Procedure ◽  
Frozen Elephant Trunk Technique

Abstract We report a case of a 51-year-old male with complicated acute type A aortic dissection who initially underwent a supracoronary and aortic arch replacement using frozen elephant trunk technique. False-lumen perfusion was revealed later which resulted in the collapse of the true lumen. Endovascular fenestration of the dissection flap was performed. True-lumen reperfusion with false-lumen regression was achieved. Endovascular fenestration using a re-entry catheter represents an efficient and safe treatment approach for this rare but serious complication.

scholarly journals Can Frozen Elephant Trunk Cure Type I Dissection Confined to Thoracic Aorta in Marfan Syndrome?

2020 ◽  
Vol 109 (4) ◽  
pp. 1174-1182 ◽  
Author(s):  
Yu Chen ◽  
Wei-Guo Ma ◽  
Jian-Rong Li ◽  
Jun Zheng ◽  
Qing Li ◽  
...  
Keyword(s):  
Marfan Syndrome ◽  
Thoracic Aorta ◽  
Type I ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk

scholarly journals The frozen elephant trunk technique in acute DeBakey type I aortic dissection

2020 ◽  
Vol 28 (3) ◽  
pp. 411-418
Author(s):  
Davut Çekmecelioğlu
Keyword(s):  
Aortic Dissection ◽  
Thoracic Aorta ◽  
Median Sternotomy ◽  
Type I ◽  
Frozen Elephant Trunk ◽  
Descending Thoracic Aorta ◽  
Elephant Trunk ◽  
Mortality And Morbidity ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

Although advances in the field of cardiovascular surgery have improved outcomes for patients with acute DeBakey type I aortic dissection, postoperative in-hospital mortality and morbidity remain substantial. The frozen elephant trunk technique has become a treatment option for this disease and was developed primarily to extend repair into the proximal descending thoracic aorta during aortic arch repair (because the descending thoracic aorta is largely inaccessible via median sternotomy), thus avoiding, delaying, or facilitating subsequent repair of residual native aorta. In this review, we discuss the evidence for and future development of frozen elephant trunk reconstruction for acute DeBakey type I aortic dissection.

Additional frozen elephant trunk as a bailout for a misdeployed frozen elephant trunk in the false lumen in a patient with acute aortic dissection

2019 ◽  
Author(s):  
Koichi Tamai ◽  
Daijiro Hori ◽  
Koichi Yuri ◽  
Atsushi Yamaguchi
Keyword(s):  
Computed Tomography ◽  
Blood Flow ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Transoesophageal Echocardiography ◽  
Frozen Elephant Trunk ◽  
True Lumen ◽  
Elephant Trunk ◽  
Descending Aorta

Abstract Using a frozen elephant trunk (FET) in patients with acute aortic dissection is an effective method to induce aortic remodelling after surgery. A 40-year-old man with Stanford type A acute aortic dissection underwent emergency total arch replacement with FET. The FET was inserted into the descending aorta under direct vision. However, transoesophageal echocardiography after the deployment of the FET revealed that it was misdeployed in the false lumen. An additional FET was deployed in the true lumen to redirect the blood flow to the true lumen. The patient was discharged from the hospital without any major complications. Computed tomography 6 months after surgery revealed enhanced aortic remodelling without any signs of stent graft-induced new entry. Additional deployment of a FET into the true lumen could be an option for a misdeployed FET in the false lumen.

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