scholarly journals Frozen Elephant Trunk in Aortic Arch Disease: Different Devices for Different Pathologies

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1090
Author(s):  
Carlo Mariani ◽  
Giacomo Murana ◽  
Alessandro Leone ◽  
Luca Di Di Marco ◽  
Davide Pacini
Keyword(s):  
Aortic Arch ◽  
Thoracic Aorta ◽  
Stent Graft ◽  
Intramural Hematoma ◽  
Distal Anastomosis ◽  
Frozen Elephant Trunk ◽  
Descending Thoracic Aorta ◽  
Elephant Trunk ◽  
Remarkable Feature ◽  
Early Results

The frozen elephant trunk technique (FET) requires the use of a pre-assembled hybrid prosthesis consisting of a standard Dacron vascular portion to replace the aortic arch and a stent graft component, which is placed into the proximal descending thoracic aorta (DTA) anterogradely in the proximal descending thoracic aorta. In Europe, two hybrid prostheses are available: the E-evita Open Plus hybrid stent graft system provided by JOTEC (Hechingen, Germany) and the ThoraflexTM Hybrid (Vascutek, Inchinnan Scotland). Recommendations for use are extensive pathologies of the arch in case of acute and chronic aortic dissection, degenerative aneurysm and intramural hematoma. The FET approach allows the replacement of the whole arch in one stage with the option of direct treatment of the proximal descending thoracic aorta based on the stent component, creating a safe landing zone for further endovascular treatment more distally. The remarkable feature of this technique is the possibility to perform more proximally (from zone 3 to zone 0) the distal anastomosis in to the arch. This allows for an easier distal anastomosis, reduced hypothermic circulatory arrest time and decreased risk of paraplegia (<5%). Early results are promising and according to the most recent series the rate of developing post-operative renal insufficiency ranges from 3 to 10%, the risk of stroke from 3% to 8% and mortality from 8–15%. The aim of the article will be to provide some knowledge about the use and application of FET procedures in different aortic situations.

scholarly journals Contained rupture of arch aneurysm managed with total arch, frozen elephant trunk and endograft

2019 ◽  
Vol 2019 (2) ◽  
Author(s):  
Michael Ibrahim ◽  
Roland Assi ◽  
Fenton McCarthy ◽  
Michael A Golden ◽  
Wilson Y Szeto
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Arch ◽  
Stent Graft ◽  
Thoracic Aortic Aneurysm ◽  
Aortic Arch Aneurysm ◽  
Distal Anastomosis ◽  
Complex Case ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Arch Aneurysm

We here describe a complex case of a 75-year-old man presenting with contained rupture of an aortic arch aneurysm in the presence of a second thoracic aortic aneurysm. He was managed with emergent total arch replacement with frozen elephant trunk. Another stent-graft was used to achieve hemostasis at the distal anastomosis. He later underwent TEVAR extension to manage his second aneurysm in a staged fashion. This case demonstrates a number of important concepts in the evolving interaction between open and endovascular therapies of the aortic arch, particularly in the emergent setting.

scholarly journals Contained rupture of arch aneurysm managed with total arch, frozen elephant trunk and endograft

2019 ◽  
Vol 2019 (1) ◽  
Author(s):  
Michael Ibrahim ◽  
Roland Assi ◽  
Fenton McCarthy ◽  
Michael A Golden ◽  
Wilson Y Szeto
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Arch ◽  
Stent Graft ◽  
Thoracic Aortic Aneurysm ◽  
Aortic Arch Aneurysm ◽  
Distal Anastomosis ◽  
Complex Case ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Arch Aneurysm

We here describe a complex case of a 75-year-old man presenting with contained rupture of an aortic arch aneurysm in the presence of a second thoracic aortic aneurysm. He was managed with emergent total arch replacement with frozen elephant trunk. Another stent-graft was used to achieve hemostasis at the distal anastomosis. He later underwent TEVAR extension to manage his second aneurysm in a staged fashion. This case demonstrates a number of important concepts in the evolving interaction between open and endovascular therapies of the aortic arch, particularly in the emergent setting.

The zone 2 concept and distal stent graft positioning in TH 2–3 are associated with high rates of secondary aortic interventions in frozen elephant trunk surgery

2021 ◽  
Author(s):  
Markus Liebrich ◽  
Efstratios I Charitos ◽  
Sebastian Schlereth ◽  
Helfried Meißner ◽  
Tobias Trabold ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Type A ◽  
Distal Anastomosis ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Hybrid Prosthesis ◽  
Elephant Trunk Procedure ◽  
Graft Length ◽  
Aortic Dissection Type A

Abstract OBJECTIVES The goal of this study was to investigate the association between the localization of the distal anastomosis (zone 2/3), the stent graft length (100–160 mm), the position of the distal end of the hybrid prosthesis and the need for secondary aortic intervention (SAI) in acute and chronic thoracic aortic disease after the frozen elephant trunk procedure. METHODS From 2009 through 2020, a total of 232 patients (137 men; mean age, 61.7 ± 13.8 years) were treated with the frozen elephant trunk procedure. The main indications were acute aortic dissection type A (n = 106, 46%), chronic aortic dissection type A (n = 52, 22%) and degenerative thoracic aortic aneurysm (n = 74, 32%). RESULTS The rate of SAI was significantly higher when we performed a distal anastomosis in zone 2 rather than in zone 3, whereas the rate of SAI was less frequent if the distal positioning of the hybrid prosthesis was below TH 4–5. Combining the zone 2 concept and the short stent graft length (100 mm) was associated with a significantly higher rate of SAIs. Patients with a distal anastomosis in zone 2 were significantly less likely to have a recurrent laryngeal nerve injury (P &lt; 0.001). However, no association between a specific arch zone of a distal anastomosis and the occurrence of spinal cord injury was observed. CONCLUSIONS Rates of SAIs are highest in patients who were treated with a distal anastomosis in zone 2 and a short stent graft (100 mm) with the distal end of the hybrid prosthesis at vertebral level TH 2–3.

Suturing Fenestration of the Left Subclavian Artery Orifice in Frozen Elephant Trunk Procedure

2020 ◽  
Author(s):  
Mitsumasa Hata ◽  
Shinji Wakui ◽  
Yusuke Ishii ◽  
Rei Hinoura ◽  
Susumu Isaka ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Subclavian Artery ◽  
Distal Part ◽  
Left Subclavian Artery ◽  
Frozen Elephant Trunk ◽  
Bleeding Events ◽  
Elephant Trunk ◽  
Novel Technique ◽  
Elephant Trunk Procedure

AbstractThe frozen elephant trunk (FET) procedure enables easier replacement of the entire aortic arch because it does not require reaching the distal part of the left subclavian artery (LSCA). However, it requires additional management for reconstruction of the LSCA, which is associated with bleeding events. However, the fenestrated FET technique confers a risk of endoleakage from the fenestration site. We report our unique novel technique in which the proximal side of the hybrid stent graft is cut into V-shape around the subclavian artery and sutured continuously around the orifice of the subclavian artery during aortic stump fixation.

Emergency Stent-Graft Placement for Impending Rupture of the Descending Thoracic Aorta

2002 ◽  
Vol 9 (2_suppl) ◽  
pp. II-72-II-78 ◽  
Author(s):  
H. Joachim Nesser ◽  
Holger Eggebrecht ◽  
Dietrich Baumgart ◽  
Christian Ebner ◽  
Manfred Gschwendtner ◽  
...  
Keyword(s):  
Thoracic Aorta ◽  
Stent Graft ◽  
Aortic Rupture ◽  
Case Reports ◽  
Intramural Hematoma ◽  
Descending Thoracic Aorta ◽  
Thoracic Pain ◽  
Promising Alternative ◽  
Graft Placement ◽  
Impending Rupture

Purpose: To present initial experience with emergent stent-graft placement for impending rupture of the descending thoracic aorta. Case Reports: Intramural hematoma (IMH) of the descending thoracic aorta was diagnosed by transesophageal echocardiography and computed tomography in 3 patients with acute onset of severe thoracic pain. Because of signs of impending rupture, e.g., pleural effusion, sustained pain, or transadventitial bleeding, the patients underwent emergency stent-graft placement, which was successful in all cases. No procedure-related complications were observed. Follow-up to 18 months has revealed no evidence of endoleak, and all patients remain free of symptoms. Conclusions: Emergency stent-graft placement may be a promising alternative to conventional surgery in patients with impending aortic rupture due to IMH.

scholarly journals Stent graft repair in the aortic arch and descending thoracic aorta: A 4-year experience

2002 ◽  
Vol 36 (6) ◽  
pp. 1121-1128 ◽  
Author(s):  
Frank J. Criado ◽  
Nancy S. Clark ◽  
Marcos F. Barnatan
Keyword(s):  
Aortic Arch ◽  
Thoracic Aorta ◽  
Stent Graft ◽  
Descending Thoracic Aorta ◽  
Stent Graft Repair
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