The frozen elephant trunk technique.

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Aortic arch and descending aorta aneurysms often require complex, multi-stage repair.
• The traditional elephant trunk technique necessitates a secondary procedure for distal aortic repair.
• Direct surgical access to the proximal descending aorta can be challenging.

Purpose of the Study:

• To introduce and evaluate the "frozen elephant trunk" technique for single-stage repair of concomitant aortic arch and proximal descending aortic aneurysms.
• To assess the feasibility and initial outcomes of this hybrid graft approach.
• To determine the safety and efficacy of the frozen elephant trunk technique in managing complex thoracic aortic pathologies.

Main Methods:

• Adaptation of the classical elephant trunk technique using a hybrid vascular graft.
• The hybrid graft combines a conventional tube graft with a distal endovascular stented graft.
• Single-stage surgical procedure for simultaneous repair of aortic arch and proximal descending aorta.

Main Results:

• Successful exclusion of proximal descending aortic aneurysms demonstrated in initial intra- and postoperative results.
• The learning curve for the procedure is associated with minimal and acceptable increases in circulatory arrest and cerebral perfusion times.
• The technique effectively achieves a blood-tight seal in the descending aorta, overcoming access limitations.

Conclusions:

• The frozen elephant trunk technique provides a viable and effective single-stage solution for complex aortic aneurysms involving the aortic arch and proximal descending aorta.
• This approach simplifies the management of these challenging pathologies, potentially reducing the need for secondary interventions.
• Ongoing clinical evaluation includes acute aortic dissections (Type A and B), highlighting the technique's expanding applications.