title: Thoracoabdominal aortic aneurysm repair after frozen elephant trunk procedure.
abstract: OBJECTIVE
  To evaluate the feasibility and the outcomes of second-stage thoracoabdominal (TA) repair after previous frozen elephant trunk (FET) implantation.
  
  
  METHODS
  Between 2005 and 2013, 41 patients underwent open TA aortic repair in our institution. Of these, 9 patients (78% male) underwent second-stage TA repair after previous FET implantation. Feasibility and outcomes were evaluated.
  
  
  RESULTS
  The mean interval between FET implantation and second-stage TA repair was 423 days (19-1979 days). Indications for second-stage TA repair were progression in aortic diameter of atherosclerotic aneurysms in the downstream segments in 6 patients, diameter progression in post-dissection aneurysms in 2 patients and giant cell aortitis with aneurysm formation in another patient. There were no in-hospital deaths. The median intensive care unit stay was 3.5 days (range: 1-12 days) and median hospital stay was 22 days (range: 14-132 days). We did not observe symptomatic spinal cord ischaemia or stroke. One patient (11%) developed acute renal failure requiring haemodialysis.
  
  
  CONCLUSIONS
  Second-stage TA aortic repair after previous frozen elephant implantation is a feasible and effective treatment modality for patients with various pathologies of downstream aortic segments. This approach adds additional value to the conventional elephant trunk technique by providing an excellent landing zone not only for additional stent graft procedures but also for subsequent open TA repair.
authors.affiliation: Department of Cardiovascular Surgery, Hietzing Hospital, Vienna, Austria s.folkmann@gmx.at.
authors.forename: Sandra
authors.initials: S
authors.lastname: Folkmann
authors.affiliation: Department of Cardiovascular Surgery, Hietzing Hospital, Vienna, Austria.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Weiss
authors.affiliation: Department of Cardiovascular Surgery, Hietzing Hospital, Vienna, Austria.
authors.forename: Harald
authors.initials: H
authors.lastname: Pisarik
authors.affiliation: University Hospital Zurich, Zurich, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
authors.affiliation: Department of Cardiovascular Surgery, Hietzing Hospital, Vienna, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Grabenwoger
mesh_terms: D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000453:epidemiology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: Frozen elephant trunk implantation; Second stage; Thoracoabdominal aortic replacement