Role of Computed Tomography Angiography in Preoperative Planning, Postoperative Assessment of Frozen Elephant Trunk...

The frozen elephant trunk procedure represents a major advance in treating complex thoracic aortic pathologies involving the arch and proximal descending aorta by enabling single-stage hybrid repair. Among available devices, the E-vita Open Plus prosthesis has emerged as a leading solution due to its advanced design features, enhancing procedural safety, technical precision, and long-term outcomes. Essential to the procedure is multidetector computed tomography angiography (CTA), which serves as the gold standard imaging modality for preoperative planning, postoperative assessment, and long-term surveillance. The E-vita Open Plus prosthesis, when paired with advanced perfusion strategies such as early distal aortic perfusion and selective antegrade cerebral perfusion, has demonstrated reduced neurologic complications and enhanced durability. This review explores the integral role of CTA in guiding all phases of the FET procedure using the E-vita Open Plus. Preoperatively, CTA provides high-resolution anatomical detail for prosthesis sizing, identifying dissection planes, and assessing involvement of supra-aortic branches. Postoperatively, it enables accurate evaluation of graft position, patency, and complications such as endoleaks, distal stent-induced new entry tears, graft kinking, or malposition. Serial CTA surveillance also provides essential insights into aortic remodeling, particularly in evaluating true lumen expansion and false lumen thrombosis-key predictors of favorable long-term outcomes. Clinical outcomes from high-volume centers report encouraging survival and reintervention-free rates. This review synthesizes the evolving evidence and underscores CTA's important role in optimizing patient selection, procedural planning, and outcome evaluation in contemporary FET surgery.