Total arch replacement with a branched frozen elephant trunk with potential to reliably reconstruct a narrow-diameter vertebral anomalous artery using a self-expandable stent graft

We describe a total arch replacement using a hybrid frozen elephant trunk device. The procedure required reconstruction of the left vertebral anomalous artery using a triple branched stented anastomosis frozen elephant trunk repair. The novelty of this procedure lies in the impressive results that we obtained at this preliminary stage. The good results indicated an effective safe technique that facilitates aortic arch reconstruction using the hybrid frozen elephant trunk for an arch aneurysm with a left vertebral anomalous artery. Three-dimensional computed tomography performed 6 months postoperatively showed a well-reconstructed aortic arch and left vertebral anomalous artery. The use of self-expandable stent grafts may facilitate reconstruction of the left vertebral anomalous artery and is expected to improve patency. In this case, a longer follow-up with further procedural improvements is still necessary to pass this preliminary stage and obtain a definitive optimal outcome with an advantage in operating time.