Transfemoral stent-graft placement to treat a complication of the frozen elephant trunk procedure.
OBJECTIVE
To report a novel complication of a hybrid "frozen elephant trunk" endograft used in the treatment of a multisegmentally diseased aorta.


METHODS
A 53-year-old man with chronic type A aortic dissection and previous replacement of the supracoronary ascending aorta underwent a "frozen elephant trunk" procedure using a hybrid endograft. The stent-graft was placed deep in the descending aorta to cover the multiple distal re-entries. Due to ineffective covering of the re-entries, a patent false lumen led to rapid repressurization of the false lumen immediately distal to the circumferential elephant trunk anastomosis. Compression of the non-stented portion of the hybrid endograft caused a functional aortic stenosis, with severe hemodynamic consequences. Endovascular treatment of the compression by retrograde transfemoral placement of a stent-graft in the non-stented portion of the hybrid endograft achieved free flow in the distal aorta.


CONCLUSIONS
This case documents a new complication of the frozen elephant trunk procedure; a pseudocoarctation from a repressurized proximal false lumen was successfully managed with a stent-graft to support the non-stented segment of the hybrid endograft.
Easo
Jerry
J
Department of Cardiothoracic Surgery, Klinikum Oldenburg, Germany. easo@herzchirurgie-oldenburg.de
Dapunt
Otto
O
Natour
Ehsan
E
Hoelzl
Philipp
P
Dangel
Gerd
G
Chavan
Ajay
A
D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D002908:Chronic Disease; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D015641:Radiography, Interventional; D012039:Regional Blood Flow; D015607:Stents; D016896:Treatment Outcome