Aorta

Interquartile range

Surgery

Cardiology

Aortic arch

Dissection (medical)

Aortic aneurysm

Elephant trunks

Aortic dissection

Medicine

Bentall procedure

Descending aorta

Aneurysm

European Journal of Vascular and Endovascular Surgery

<h3>Objective</h3> To evaluate outcomes of patients with acute complicated or chronic Type B or non-A non-B aortic dissection who underwent the frozen elephant trunk (FET) technique. <h3>Methods</h3> Between April 2013 and July 2019, 41 patients presenting with acute complicated (<i>n</i> = 29) or chronic (<i>n</i> = 12) descending thoracic aortic dissection were treated by the FET technique, which was the treatment of choice when supra-aortic vessel transposition would not suffice to create a satisfactory proximal landing zone for endovascular aortic repair, when a concomitant ascending or arch aneurysm was present, or in patients with connective tissue diseases. <h3>Results</h3> One patient (2%) died intra-operatively secondary to an aortic rupture in dwnstream aortic segments. No post-operative deaths occurred. Four patients (10%) suffered a non-disabling posto-operative stroke and were discharged with no clinical symptoms (modified Rankin Scale [mRS] 0, <i>n</i> = 1), no significant disability (mRS 1, <i>n</i> = 2), or with slight disability (mRS 2, <i>n</i> = 1). No spinal cord ischaemia was observed. The primary entry tear was either surgically resected or excluded from circulation in all patients. During follow up, one patient (2%) died after two years (not aorta related) and 16 patients (39%) underwent an aortic re-intervention after 7.7 [interquartile range 0.7, 15.8] months (endovascular aortic repair: <i>n</i> = 14; open thoraco-abdominal aortic replacement: <i>n</i> = 1, hybrid approach: <i>n</i> = 1). <h3>Conclusion</h3> The FET technique is an effective treatment option for acute complicated and chronic Type B or non-A non-B aortic dissection in patients in whom primary endovascular aortic repair is non-feasible. While the post-operative outcome is acceptable with a relatively low incidence of non-disabling strokes, this study also underlines the considerable need for aortic re-interventions. Continuous follow up of all patients undergoing the FET procedure is essential.

The Frozen Elephant Trunk Technique for the Treatment of Type B and Type Non-A Non-B Aortic Dissection