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The Journal of Cardiovascular Surgery 2022 August;63(4):425-33

DOI: 10.23736/S0021-9509.22.12393-1


language: English

Endovascular reintervention after frozen elephant trunk: where is the evidence?

Alexander GERAGOTELLIS 1, Abedalaziz O. SURKHI 2, Matti JUBOURI 3, Ayah S. ALSMADI 4, Yazan EL-DAYEH 5, Fatima KAYALI 6, Idhrees MOHAMMED 7, Mohamad BASHIR 8

1 Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; 2 Faculty of Medicine, Al-Quds University, Jerusalem, Israel; 3 Hull York Medical School, University of York, York, UK; 4 Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 5 Faculty of Medicine, University of Debrecen, Debrecen, Hungary; 6 School of Medicine, University of Central Lancashire, Preston, UK; 7 Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, Tamil Nadu, India; 8 Department of Vascular and Endovascular Surgery, Velindre University NHS Trust, Health Education and Improvement Wales (HEIW), Cardiff, UK

The introduction of the single-step hybrid frozen elephant trunk (FET) procedure for total arch replacement has revolutionized the field of aortovascular surgery. FET has proven to achieve excellent results in the repair of complex thoracic aorta pathologies. However, there remains a risk of reintervention post-FET for a variety of causes. This secondary intervention can either be performed endovascular, with thoracic endovascular aortic repair (TEVAR), or via open surgery. Multiple FET hybrid prosthesis are commercially available, each requiring different rates of endovascular reintervention. The current review will focus on providing an overview of the reintervention rates for main causes in relation to the FET grafts on the market. In addition, strategies to prevent reintervention will be highlighted. A comprehensive literature search was conducted on multiple electronic databases including PubMed, Ovid, Scopus and Embase to highlight the evidence in the literature on endovascular reintervention after FET. The main causes for secondary intervention are distal stent graft-induced new entry (dSINE), endoleak and negative aortic remodeling, and to a much lesser extent, graft kinking and aorto-esophageal fistulae. In addition, it is clear that the Thoraflex Hybrid (Terumo Aortic, Inchinnan, UK) is the superior FET device, showing excellent reintervention rates for all the above causes. Interestingly, the choice of FET device as well as its size and length can help prevent the need for reintervention. The FET procedure is indeed associated with excellent clinical outcomes, however, the need for reintervention may still arise. Importantly, the Thoraflex Hybrid prosthesis has shown excellent results when it comes to endovascular reintervention. Finally, several strategies exist that can prevent reintervention.

KEY WORDS: Endovascular procedures; Aorta; Surgical procedures, operative

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