Frozen elephant trunk as an effective alternative to open and hybrid two-stage procedures for complex aortic disease.

Abstract

he management of aneurysms in-volving the aortic arch and de-scending aorta poses a technical challenge and is an area of ongoing devel-opment and innovation. Although one-stage replacement of the aorta is feasi-ble and has been the mainstay of surgi-cal treatment of extensive thoracic aneu-rysms in the past, the technical complex-ity and associated morbidity of one-stage procedures has led to the development of two-stage open and hybrid procedures. In this way the operating surgeon or endo-vascular physician is able to complete the distal aortic reconstruction following the patient’s recovery from the first main re-constructive procedure and by accessing the site for intervention away from pre-vious surgery. More recently, and with the advent of endovascular technology, a one-stage complete repair of extensive thoracic aneurysms and dissections has been achieved, aiming at decreasing the two-stage procedures. The “frozen ele-phant trunk” technique, which involves the single-stage combination of open an-tegrade stent graft insertion into the de-scending aorta and conventional surgi-cal reconstruction of the aortic arch has shown promising results.The aim of this review is to acquaint the modern cardiovascular physician with the evolution and appraisal of surgical treatments for extensive thoracic aneu-rysms, with emphasis on the frozen ele-phant trunk, its technical aspects, current applications and outcomes.