Key result
The frozen elephant trunk technique for penetrating aortic ulcers involving the aortic arch resulted in an 18% perioperative mortality rate and a 9% rate of major stroke.
Why the study?
The authors sought to evaluate the use of the frozen elephant trunk technique for treating penetrating aortic ulcers involving the aortic arch.
Cohort (n=34)
Yes
The frozen elephant trunk technique is a viable option for complex penetrating aortic ulcers of the arch unsuitable for TEVAR, but it carries significant risks of perioperative mortality and neurological injury, and frequently requires secondary interventions.
May support FET for selected arch ulcers lacking TEVAR landing zones; leaves open comparative efficacy versus alternatives.
OBJECTIVES: Our goal was to evaluate the use of the frozen elephant trunk (FET) technique for the treatment of penetrating aortic ulcers involving the aortic arch. METHODS: Between January 2008 and January 2020, a total of 34 patients had the FET technique at 3 aortic centres. The indication for the FET technique was unsuitability for thoracic endovascular aortic repair due to the lack of a sufficient proximal landing zone even after supra-aortic rerouting (subclavian transposition, double transposition), ectasia of the ascending aorta/aortic arch (>40 mm) and/or a shaggy proximal thoracic aorta. RESULTS: Additional cardiac procedures were performed in 14 patients (41%), and the beating heart technique was used in 7 patients (21%). Perioperative mortality was 18% (n = 6); 3 of these patients had a major stroke (9%). No case of spinal cord ischaemia was observed, and 2 patients (6%) developed a non-disabling stroke. After a median follow-up of 7 (first quartile: 1; third quartile 29) months, 2 patients (6%) died (1 of malignant disease and 1 of an unclear cause); 10 additional aortic interventions in all aortic segments (29%; endovascular: n = 8 [24%] and conventional surgical: n = 2 [6%]) were performed in 8 patients. CONCLUSIONS: The FET technique is a good treatment option for patients with penetrating aortic ulcers involving the aortic arch unsuitable for thoracic endovascular aortic repair. However, the high obliterative atherosclerotic load in these patients is accompanied by an un-neglectable risk of perioperative neurological injury. Concomitant cardiac surgical procedures are frequently needed. Patients commonly require secondary aortic procedures in all aortic segments, emphasizing the need for thorough primary conceptual planning and stringent follow-up.
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Kreibich et al. (2020) conducted a cohort in Penetrating aortic ulcers involving the aortic arch (n=34). Frozen elephant trunk (FET) technique was evaluated on Perioperative mortality. The frozen elephant trunk technique for penetrating aortic ulcers involving the aortic arch resulted in an 18% perioperative mortality rate and a 9% rate of major stroke.
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