Redo Frozen Elephant Trunk After Endovascular Arch Repair

The authors report the case of a 73-year-old man with a history of acute type A aortic dissection, who was treated with urgent hemiarch repair and later underwent endovascular arch repair with a fenestrated stent graft. After several years, he presented with fever and anemia. Diagnostic investigations revealed the presence of a huge aortic pseudoaneurysm extending to subcutaneous tissue from a sternal fistula, along with a type IA endoleak due to proximal stent graft infolding. The surgical strategy and techniques are explained in the video. This example highlights that, when dealing with aortic pathology, tailored and timely surgery is crucial. Careful preoperatory planning, even in urgent settings, is key to avoiding potential catastrophic outcomes. Moreover, aortic patients need long-term surveillance with meticulous clinical and radiological follow-up to identify any early need for reintervention. Since these patients often undergo secondary operations, techniques such as the arch vessels’ switch and new devices such as the T-next can help simplify the following procedures. 

References

1. Gatta E, Berretta P, Vento V, Di Eusanio M. Arch vessels' switch in frozen elephant trunk: a new technique to facilitate the second-stage endovascular thoraco-abdominal aorta repair. Eur J Cardiothorac Surg. 2022 Dec 2;63(1):ezac588. doi: 10.1093/ejcts/ezac588. PMID: 36579884.
2. Berretta P, Galeazzi M, Malvindi PG, Vento V, Gatta E, Di Eusanio M. Frozen elephant trunk with T-NEXT. Ann Cardiothorac Surg 2025;14(4):314-315. doi: 10.21037/acs-2025-evet-0017

Disclaimer

The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.