Case Report: Endovascular repair for true lumen collapse after frozen elephant trunk for type A aortic dissection

Frozen elephant trunk (FET) was applied in the treatment of type A aortic dissection, enabling one-stage repair of the aortic arch and proximal descending aorta while promoting true lumen expansion. However, inadvertent FET deployment into the false lumen is a rare but catastrophic complication that may cause true lumen collapse and life-threatening visceral malperfusion, with limited reports on its endovascular management.

Here, we present the case of a 44-year-old female who underwent Bentall procedure, total arch replacement, and FET implantation for acute type A aortic dissection at a local hospital. Postoperatively, she developed visceral malperfusion manifesting as abdominal distension, hepatic and renal dysfunction, and elevated lactate levels. Computed tomography angiography revealed that the FET stent had been inadvertently deployed into the false lumen, resulting in true lumen collapse. Emergency thoracic endovascular aortic repair was performed, establishing a "FET-false lumen-true lumen" pathway with an additional stent graft to redirect aortic flow into the true lumen. Computational fluid dynamics analysis showed that the postoperative hemodynamics have been significantly improved. The patient's organ function normalized, and she was discharged two weeks later, remaining asymptomatic at 8-month follow-up.

Endovascular reintervention with additional stent grafting to establish a flow-redirection pathway is a feasible and effective strategy for true lumen collapse following inadvertent FET deployment into the false lumen. Prompt recognition, timely imaging confirmation, and immediate intervention are paramount to mitigating the risks associated with this serious complication.