Endovascular Aortic Repair After Proximal Stent Graft Migration of a Modified Frozen Elephant Trunk

2020 ◽  
Vol 15 (2) ◽  
pp. 169-172
Author(s):  
Alex R. Dalal ◽  
Albert J. Pedroza ◽  
Shinichi Iwakoshi ◽  
Jason T. Lee ◽  
Dominik Fleischmann ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Artery Bypass ◽  
Frozen Elephant Trunk ◽  
Type B Aortic Dissection ◽  
True Lumen ◽  
Endovascular Technique ◽  
Elephant Trunk ◽  
Ct Angiogram ◽  
Type A Dissection ◽  
Graft Migration

We describe the endovascular repair for a proximal endograft migration following a modified frozen elephant trunk (mFET) repair for a retrograde type A dissection (retro-A AD). A 40-year-old man presented with a type B aortic dissection that progressed to a retro-A AD. He was emergently taken to the operating room for an mFET repair. Computed tomography (CT) angiogram on the day of discharge revealed that the proximal end of the endograft migrated through the primary intimal tear resulting in obstruction of true lumen flow. The patient returned to the catheterization lab for endovascular repair utilizing a through-and-through wire to extend the endograft proximally and a left carotid-subclavian artery bypass. This complication highlights the importance of postoperative CT surveillance and the endovascular technique utilized to restore aortic true lumen flow.

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 Surgical Strategies for Type B Aortic Dissection by Frozen Elephant Trunk

2018 ◽  
Vol 58 (9) ◽  
pp. 151-157 ◽  
Author(s):  
Yuichi Matsuzaki ◽  
Takuma Yamasaki ◽  
Yu Hohri ◽  
Takeshi Hiramatsu
Keyword(s):  
Aortic Dissection ◽  
Type B ◽  
Frozen Elephant Trunk ◽  
Type B Aortic Dissection ◽  
Elephant Trunk ◽  
Surgical Strategies

Retrograde Type A Dissection after Ascending Aorta Involved Endovascular Repair and Its Surgical Repair with Stented Elephant Trunk

2019 ◽  
Vol 58 ◽  
pp. 198-204.e1 ◽  
Author(s):  
Zhao An ◽  
Meng-Wei Tan ◽  
Zhi-Gang Song ◽  
Hao Tang ◽  
Fang-Lin Lu ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Surgical Repair ◽  
Type A ◽  
Ascending Aorta ◽  
Elephant Trunk ◽  
Type A Dissection

scholarly journals Type B aortic dissection repair using a Thoraflex hybrid prosthesis in a setting of aberrant left vertebral artery

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Saifullah Mohamed ◽  
Akshay J Patel ◽  
Yassir Iqbal ◽  
Khurum Mazhar ◽  
Uday Dandekar ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Vertebral Artery ◽  
Left Vertebral Artery ◽  
Type B ◽  
Frozen Elephant Trunk ◽  
Type B Aortic Dissection ◽  
Elephant Trunk ◽  
Aortic Replacement ◽  
Increased Risk ◽  
Hybrid Prosthesis

Abstract Type B aortic dissection (TBAD) is often managed conservatively with intervention reserved for complicated cases. Strategies for complicated and uncomplicated TBAD can involve optimal medical therapy, thoracic endovascular aortic replacement and open surgical repair of TBAD with replacement of the affected segment of aorta and reimplantation of aortic branches. The frozen elephant trunk technique has been reported to be a successful surgical strategy in patients with complicated TBAD, particularly in patients who possess unfavourable aortic arch anatomy for endovascular stenting or at increased risk of retrograde Type A aortic dissection. The Thoraflex is a commercially available aortic graft, manufactured by Vascutek®. We describe a successful case of addressing complicated TBAD with rare variant aortic anatomy using a Thoraflex hybrid frozen elephant trunk graft and reimplantation of the aberrant left vertebral artery to the perfusion limb of the Thoraflex graft.

Management of a Compromised Frozen Elephant Trunk Due to Acute Type B Aortic Dissection

2020 ◽  
Vol 54 (8) ◽  
pp. 756-759
Author(s):  
Amer Harky ◽  
Robert K. Fisher ◽  
Mark L. Field
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
False Lumen ◽  
Acute Type ◽  
Type B ◽  
Frozen Elephant Trunk ◽  
Type B Aortic Dissection ◽  
Elephant Trunk ◽  
Thoracoabdominal Aorta

Purpose: To report a case who required a thoracic endovascular stenting (TEVAR) following the deployment of frozen elephant trunk due to false lumen expansion Case Report: A 47 years old male patient undergone emergency repair of acute type A aortic dissection in 2011 with bioprosthetic aortic root conduit. Seven years later he presented with moderate aortic valve disease and expanding chronic dissection of the aortic arch, therefore a redo operation with replacement of the prosthetic aortic valve, ascending aorta, total arch and deployment of frozen elephant trunk and he was discharged in good health. Several days post discharge he presented with new onset of chest pain and a new dissection involved the thoracoabdominal aorta was noted pressing on the true lumen and the frozen elephant trunk. Following a multi-disciplinary team meeting, TEVAR was deemed as a most appropriate approach and this was achieved successfully, and patient was discharged. At 1 year of follow up, he remains well and asymptomatic. Conclusion: Close imaging follow-up following deployment of a FET is mandatory. A new acute Type B aortic dissection distal to the FET, that causes false lumen propagation parallel to the stented portion, is a surgical emergency and further intervention mandated.

Combined Frozen Elephant Trunk and Endovascular Repair for Extensive Thoracic Aortic Aneurysms

2015 ◽  
Vol 29 (5) ◽  
pp. 905-912 ◽  
Author(s):  
Amedeo Anselmi ◽  
Vito Giovanni Ruggieri ◽  
Majid Harmouche ◽  
Olivier Fouquet ◽  
Adrien Kaladji ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Aortic Aneurysms ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Thoracic Aortic Aneurysms

scholarly journals Endovascular rescue for malpositioned frozen elephant trunk into the false lumen

2021 ◽  
Author(s):  
Daichi Takagi ◽  
Takuya Wada ◽  
Wataru Igarashi ◽  
Takayuki Kadohama ◽  
kentaro kiryu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Transesophageal Echocardiography ◽  
Ultrasound Guidance ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Frozen Elephant Trunk ◽  
True Lumen ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Intraoperative Transesophageal Echocardiography

We describe a case of frozen elephant trunk deployment unintentionally malpositioned into the false lumen. An 83-year-old man underwent total arch repair with a frozen elephant trunk for type A acute aortic dissection complicated by mesenteric malperfusion. However, intraoperative transesophageal echocardiography showed expansion of the false lumen in the descending aorta, suggesting a malpositioned frozen elephant trunk into the false lumen. Endovascular fenestration of the dissecting flap and subsequent endograft deployment from the inside of the malpositioned frozen elephant trunk graft to the true lumen of the descending aorta was successfully performed under intravascular ultrasound guidance.

scholarly journals Using an Endovascular Strategy in the Open Setting: The Challenges of Hybrid Repair Using Frozen Elephant Trunk in an Extensively Dilated Aorta Associated with Coarctation

Aorta ◽  
2021 ◽  
Vol 09 (05) ◽  
pp. 190-192
Author(s):  
Bertram Harrington ◽  
Iain McPherson ◽  
Christopher Bayliss ◽  
Sion Barnard ◽  
James McCaslin ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Endovascular Repair ◽  
Surgical Repair ◽  
Balloon Dilation ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Hybrid Repair ◽  
Staged Approach

AbstractWith both stenosis and aneurysm, repairing a severely tortuous and coarcted aorta can present certain difficulties. The advent of hybrid arch frozen elephant trunk techniques, as well as other endovascular solutions, has produced safer surgical repair methods for such cases. We present the reconstruction and repair of a Type-1 thoracoabdominal aortic aneurysm using a staged approach in less-than-optimal anatomy. Interventions included hybrid frozen elephant trunk, balloon dilation, and thoracic endovascular repair.

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