The Frozen Elephant Trunk (FET) technique using the FROZENIX？ J-graft simplifies total arch replacement but poses challenges in patients with anatomically complex aortas. We report two cases of simultaneous ascending and aortic arch replacement using FROZENIX and thoracic endovascular aortic repair (TEVAR) via the ascending aorta in such anatomically challenging cases. Case 1: A 78-year-old man with a prior Y-graft replacement and TEVAR for abdominal aortic aneurysm presented with a tortuous descending aorta, which made device advancement difficult. He underwent successful total arch replacement using FROZENIX combined with TEVAR via the ascending aorta. Case 2: A 77-year-old man with chronic renal failure and a large aortic arch aneurysm underwent the same combined procedure with favorable results. Both patients recovered without neurological or renal complications and were discharged in stable condition. Simultaneous FET and TEVAR via the ascending aorta may offer a viable single-stage alternative for high-risk or anatomically complex cases.
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