In situ fenestration of a frozen elephant trunk prosthesis to recanalize the left subclavian artery

Maintaining left subclavian artery (LSA) patency is essential for preventing spinal cord ischemia before extensive aortic coverage. We present a case of in situ fenestration on a zone 2 frozen elephant trunk graft to restore the native LSA perfusion after a prior LSA bypass occlusion. Fenestration was performed using the electrified wire technique, followed by balloon-expandable covered stent implantation. The procedure was completed with distal thoracic extensions. The postoperative imaging confirmed LSA patency. This approach offers a feasible, reproducible solution for selected patients requiring LSA recanalization after frozen elephant trunk.