title: Reversed Frozen Elephant Trunk Technique to Treat a Type II Thoracoabdominal Aortic Aneurysm.
abstract: To describe a hybrid technique of reversed frozen elephant trunk to treat thoracoabdominal aortic aneurysms (TAAA) through an abdominal only approach.
  
  
  
  The technique is demonstrated in a 29-year-old Marfan patient with a chronic type B aortic dissection previously treated with a thoracic stent-graft who presented with a thoracoabdominal false lumen aneurysm. Through an open distal retroperitoneal approach to the abdominal aorta, a frozen elephant trunk graft was implanted over a super-stiff wire upside down with the stent-graft component in the thoracic aorta. Following deployment of the stent-graft proximally and preservation of renovisceral perfusion in a retrograde manner, the renovisceral vessels were sequentially anastomosed to the elephant trunk graft branches, thus reducing the ischemia time of the end organs. The aortic sac was then opened, and the distal part of the hybrid graft was anastomosed with a further bifurcated graft to the iliac vessels.
  
  
  
  The reversed frozen elephant trunk technique is feasible for hybrid treatment of TAAAs via an abdominal approach only. This has the benefit of substantially reducing the trauma of thoracic exposure, thus preserving major benefits of open thoracoabdominal surgery, such as the presence of short bypasses to the renovisceral vessels and reimplantation of lumbar arteries to reduce spinal cord ischemia.
authors.affiliation: 1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, Hamburg, Germany.
authors.forename: E Sebastian
authors.initials: ES
authors.lastname: Debus
authors.affiliation: 1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, Hamburg, Germany.
authors.forename: Tilo
authors.initials: T
authors.lastname: Kölbel
authors.affiliation: 1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, Hamburg, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Wipper
authors.affiliation: 1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, Hamburg, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Diener
authors.affiliation: 2 German Aortic Center Hamburg, Department of Cardiothoracic Surgery, University Heart Center, Hamburg, Germany.
authors.forename: Beate
authors.initials: B
authors.lastname: Reiter
authors.affiliation: 2 German Aortic Center Hamburg, Department of Cardiothoracic Surgery, University Heart Center, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Detter
authors.affiliation: 1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, Hamburg, Germany.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tsilimparis
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D002908:Chronic Disease; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000150:complications* / Q000175:diagnosis; D015607:Stents; D016896:Treatment Outcome
keywords: bypass graft; hybrid procedure; renovisceral vessels; retroperitoneal approach; reversed frozen elephant trunk prosthesis; stent-graft; thoracic endovascular aortic repair; thoracoabdominal aortic aneurysm