Reversed Frozen Elephant Trunk Technique to Treat a Type II Thoracoabdominal Aortic Aneurysm

Purpose: To describe a hybrid technique of reversed frozen elephant trunk to treat thoracoabdominal aortic aneurysms (TAAA) through an abdominal only approach. Technique: The technique is demonstrated in a 29-year-old Marfan patient with a chronic type B aortic dissection previously treated with a thoracic stent-graft who presented with a thoracoabdominal false lumen aneurysm. Through an open distal retroperitoneal approach to the abdominal aorta, a frozen elephant trunk graft was implanted over a super-stiff wire upside down with the stent-graft component in the thoracic aorta. Following deployment of the stent-graft proximally and preservation of renovisceral perfusion in a retrograde manner, the renovisceral vessels were sequentially anastomosed to the elephant trunk graft branches, thus reducing the ischemia time of the end organs. The aortic sac was then opened, and the distal part of the hybrid graft was anastomosed with a further bifurcated graft to the iliac vessels. Conclusion: The reversed frozen elephant trunk technique is feasible for hybrid treatment of TAAAs via an abdominal approach only. This has the benefit of substantially reducing the trauma of thoracic exposure, thus preserving major benefits of open thoracoabdominal surgery, such as the presence of short bypasses to the renovisceral vessels and reimplantation of lumbar arteries to reduce spinal cord ischemia.

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Staged Hybrid Repair of Combined Ascending/Descending Thoracic Aortic Aneurysms Using the Frozen Elephant Trunk Technique With the Cook Zenith Tx2 Stent Graft

Journal of Vascular Surgery ◽

10.1016/j.jvs.2014.05.077 ◽

2014 ◽

Vol 60 (2) ◽

pp. 545-546

Author(s):

Osvaldo Yano ◽

Vicken Melikian ◽

Daniel Pellegrini ◽

Hong T. Hua

Keyword(s):

Stent Graft ◽

Aortic Aneurysms ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Thoracic Aortic Aneurysms ◽

Hybrid Repair ◽

Elephant Trunk Technique ◽

Frozen Elephant Trunk Technique

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Progress of the treatment for extended aortic aneurysms; is the frozen elephant trunk technique the next standard in the treatment of complex aortic disease including the arch?☆

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2008.02.030 ◽

2008 ◽

Vol 33 (6) ◽

pp. 1007-1013 ◽

Cited By ~ 59

Author(s):

Matthias Karck ◽

Hiroyuki Kamiya

Keyword(s):

Aortic Disease ◽

Aortic Aneurysms ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Elephant Trunk Technique ◽

Frozen Elephant Trunk Technique

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Efficacy of entry exclusion strategy for DeBakey type III retrograde Stanford type A acute aortic dissection

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa329 ◽

2020 ◽

Author(s):

Yosuke Inoue ◽

Hitoshi Matsuda ◽

Jiro Matsuo ◽

Takayuki Shijo ◽

Atsushi Omura ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

False Lumen ◽

Type A ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Descending Aorta ◽

Type Iii ◽

Elephant Trunk Technique ◽

Frozen Elephant Trunk Technique

Abstract OBJECTIVES Resection of a primary entry tear is essential for the treatment of Stanford type A acute aortic dissection (AAAD). In DeBakey type III retrograde AAAD (DBIII-RAAAD), resection of the primary entry tear in the descending aorta is sometimes difficult. The frozen elephant trunk technique and thoracic endovascular aortic repair (TEVAR) enable the closure of the primary entry in the descending aorta. The aim of this study was to investigate the efficacy of resection or closure of primary entry, i.e. entry exclusion, in patients with DeBakey type III retrograde-AAAD. METHODS The medical records of 654 patients with AAAD who underwent emergency surgery between January 2000 and March 2019 were retrospectively reviewed, and 80 eligible patients with DeBakey type III retrograde-AAAD were divided into the excluded (n = 50; age, 62 ± 12 years) and residual (n = 30; age, 66 ± 14 years) groups according to postoperative computed tomography angiographic data of the false lumen around the primary entry. The excluded group was defined as having a postoperative false lumen at the level of the elephant trunk or thrombosis of the endograft including primary entry. Patients with early false lumen enhancement around the elephant trunk or an unresected primary entry tear after isolated hemiarch replacement were included in the residual group. The early and long-term surgical outcomes were compared between the groups. RESULTS The in-hospital mortality rate was 8% (6/80), with no significant difference observed between the excluded and the residual groups (10% and 7%, respectively; P > 0.99). Ninety-five percentage of the patients (20/21) achieved entry exclusion with stent grafts including the frozen elephant trunk procedure and TEVAR. Spinal cord ischaemia was not observed in either group. The cumulative overall survival at 5 years was comparable between the 2 groups (76% and 81% in the excluded and residual groups, respectively; P = 0.93). The 5-year freedom from distal aortic reoperation rate was significantly higher in the excluded group (97%) than in the residual group (97% vs 66%; P = 0.008). CONCLUSIONS Not only resection but also closure using the entry exclusion approach for DeBakey type III retrograde-AAAD utilizing new technologies including the frozen elephant trunk technique and TEVAR might mitigate dissection-related reoperations.

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Early- and mid-term aortic remodelling after the frozen elephant trunk technique for retrograde type A acute aortic dissection using the new Japanese J Graft open stent graft

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivx144 ◽

2017 ◽

Vol 25 (5) ◽

pp. 720-726 ◽

Cited By ~ 22

Author(s):

Yoshitaka Yamane ◽

Naomichi Uchida ◽

Shingo Mochizuki ◽

Tomokuni Furukawa ◽

Kazunori Yamada

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

Acute Aortic Dissection ◽

Type A ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Elephant Trunk Technique ◽

Open Stent ◽

Frozen Elephant Trunk Technique

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The „Frozen“ elephant trunk technique for the treatment of extensive thoracic aortic aneurysms: Operative results and follow-up

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2004-816660 ◽

2004 ◽

Vol 52 (S 1) ◽

Author(s):

M Karck ◽

C Hagl ◽

N Khaladj ◽

K Kallenbach ◽

A Chavan ◽

...

Keyword(s):

Aortic Aneurysms ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Operative Results ◽

Thoracic Aortic Aneurysms ◽

Elephant Trunk Technique ◽

Frozen Elephant Trunk Technique

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

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz251 ◽

2019 ◽

Cited By ~ 1

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.

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