Endovascular repair of the thoracic or thoraco-abdominal aorta following the frozen elephant trunk Procedure

Abstract BACKGROUND To evaluate the outcomes of endovascular repair of the thoraco-abdominal aorta following the frozen elephant trunk (fET) procedure. METHODS Between 10/2014 and 07/2018, 249 patients underwent thoracic or thoraco-abdominal endovascular aortic repair in our institution. Of these, 10 patients (50% male) underwent second-stage ER after previous fET implantation. Feasibility and outcomes were evaluated. RESULTS The mean interval between fET implantation and second-stage endovascular repair was 136 days (14–282 days). Indications for second-stage endovascular repair were thoraco-abdominal aortic aneurysm Crawford Type I (n=3), thoraco-abdominal aortic aneurysm Crawford Type II (n=4) and complicated residual aortic dissection after fET (n=3). We have implanted four branched custom-made devices and four off-the-shelf thoracic stent-grafts; two patients were treated using the petticoat technique via a percutaneous access. The median intensive care unit stay was 1 day (range: 0–3 days) and median hospital stay was 7 days (range: 5–12 days). Spinal chord preconditioning was performed in 70% of our patients with zero paraplegia at 30 days. Computed tomography scans at 8.5±11.4 months follow-up showed complete false lumen thrombosis of all type B aortic dissections and one type 3 endoleak with constant aneurysm diameter. Branch-patency was 100%. CONCLUSIONS Second-stage endovascular repair after previous fET is feasible with good mid-term results. This staged hybrid procedure is extremely effective in patients whose aneurysms are confined both to the arch and thoraco-abdominal aorta leading to an excellent functional result. In case of favorable anatomy endovascular repair in residual type B aortic dissection lead to complete false lumen thrombosis.