Complex aortic reconstruction using double-barrel frozen elephant trunks

We present a complex aortic reconstruction for a 60-year-old patient presented with chronic type B aortic dissection, with a large proximal entry tear in zone 3, aneurysmal degeneration in the distal arch, and a small true lumen with a calcified septum. Endovascular options were limited by a poor proximal landing zone, difficulty excluding the arch pseudoaneurysm while maintaining true and false lumen flow, lack of septal fenestrations, and a calcified septum. Open extent 2 thoracoabdominal repair carried a significantly higher risk compared with sternotomy and ascending aortic and arch replacement due to the patient size and underlying chronic obstructive pulmonary disease. The patient was not tested for connective tissue disease given age, comorbid conditions, absence of a family history of aortopathy, and no stigmata of connective tissue disease. We describe a hybrid arch reconstruction with "double-barrel" frozen elephant trunks and extension thoracic endovascular aortic repair to address a complex chronic aortic dissection. This technique may be useful in select cases of complex aortic dissection.