Recent Developments in Frozen Elephant Trunk Surgery: How Endovascular Techniques facilitate Open Surgery

Abstract The frozen elephant trunk (FET) technique has of all new developments had the most extensive impact on aortic surgery since the turn of the millennium. Open antegrade deployment of a stented portion of the main surgical graft into the inaccessible proximal descending thoracic aorta allows for simultaneous treatment of complex disease involving jointly the ascending aorta, arch and descending thoracic aorta. Prior to the advent of endovascular treatment options and hybrid strategies, extensive thoracic aortic disease required at least a two-stage repair with high cumulative operative risk. Thus, the conventional elephant trunk (ET) technique carries the risk of rupture while waiting for the second stage and a significant proportion of patients fail to return for the second-stage procedure altogether. FET was developed to maintain the advantages of the ET concept while improving distal sealing and offering a more definitive primary repair. Today, FET is used in specialised aortic centres for extensive thoracic aneurysms, acute and chronic aortic dissections, post-dissection aneurysmal degeneration, and selected prophylactic indications.