In patients with extensive disease involving the aortic arch and proximal descending thoracic aorta, a frozen elephant trunk (FET) extends the repair distally by combining an open surgical ascending/transverse aortic arch replacement with deployment of a stented graft into the descending thoracic aorta. This gives my surgical colleagues a way to treat complex aneurysmal or dissecting pathology in a single operation.
During the operation, the ascending aorta and arch are resected with reconstruction of the arch under circulatory arrest (using antegrade cerebral perfusion) while the stented portion is advanced into the descending aorta to stabilize the distal segment. In acute and chronic dissection, this can expand the true lumen, reduce persistent false lumen flow, and improve distal perfusion to the body. In aneurysmal disease, it simplifies later endovascular extension if needed.
Pictured is a Thoraflex hybrid graft. I have labeled the portions of the graft to the regions they are traditionally anastomosed.
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