Use of a Novel Physician-Modified Frozen Elephant Trunk to Manage an Acute Aortic Arch Aneurysm

The frozen elephant trunk (FET) technique has become a cornerstone in managing complex aortic arch disease. However, commercial FET systems may be unavailable in emergent situations, necessitating alternative solutions.

In a 57-year-old man with an acute arch aneurysm with dissection, we replicated the FET configuration by back-table modification of a standard thoracic stent graft and combining it with a surgical graft. This novel approach, the "C-tag Endograft SanRaffaele Arrangement to Re-create a frozen Elephant trunk" (CESARE), provides a rapid, adaptable solution for emergent aortic arch repair with FET when commercial devices are unavailable.

The modified device was prepared in 65 minutes and was deployed under moderate hypothermic circulatory arrest, with uneventful recovery and excellent early imaging.

CESARE is a rapid, customizable, and widely accessible alternative to FET.

This technique enables effective arch repair when standard FET prostheses are unavailable.