Frozen Elephant Trunk: A technique which can be offered in complex pathology to fix the whole aorta in one setting

We emphasize the role of the Frozen Elephant Trunk to fix the whole aorta in one setting with special attention given to the changes taking place in vascular perfusion following correction and reconstitution of the true lumen.The optimal surgical management of chronic type B dissecting aneurysms concomitant with proximal aortic and cardiac pathology is controversial [1]. A conventional single-stage procedure with combined incisions (thoraco-sternotomy or bilateral anterior thoracotomy) is associated with increased morbidity. A staged procedure may be used, but death due to rupture of the remaining aneurysmal aorta during the interval between the first and second stages of the procedure have been recorded [2]. Arch debranching with stent grafting seems to require a similar arch exposure with compromised durability. We report the surgical treatment of a patient with complex pathology, in one stage, using the frozen elephant trunk (FET) procedure.A 65-year-old man with hypertension was admitted to our hospital because of back pain due to a large 9 cm aneurysm of the proximal descending aorta originating from a chronic type B dissection.The patient had suffered a complicated type B dissection 18 months earlier and had undergone a femoral-femoral bypass for left leg ischaemia and temporary haemodialysis for renal failure due to right kidney hypoperfusion. He had also undergone a total laryngectomy with permanent tracheostomy for laryngeal cancer one year previously.Preoperative evaluation included a coronary angiogram that revealed 90% stenosis of the proximal Left Anterior Descending (LAD) artery and total occlusion of the Right Coronary Artery (RCA). Transthoracic echocardiographic analysis revealed moderate (2+/4+) aortic regurgitation with left ventricular ejection fraction of 50%. Carotid duplex ultrasound scan demonstrated mild (<50%) carotid artery stenosis. Computed tomographic angiography (CTA) (Figure 1a and 1b) identified a degenerative aneurysm of the ascendi