Fatal delayed superior mesenteric artery thrombosis after frozen elephant trunk repair in acute type a aortic dissection with false lumen perfusion: a case report.

BACKGROUND

Frozen elephant trunk (FET) implantation is an established technique for acute Type A aortic dissection (ATAAD), promoting true lumen expansion and aortic remodeling. However, in patients with preoperative false lumen perfusion, FET carries a significant risk of postoperative false lumen thrombosis that may acutely obstruct branch vessel flow and trigger malperfusion syndrome.

CASE PRESENTATION: A 74-year-old hypertensive female presented with acute chest pain. Computed tomography angiography confirmed ATAAD with false lumen perfusion supplying all visceral arteries. Emergency ascending aorta replacement, total arch replacement, and FET implantation were performed. The patient was discharged on postoperative day twelve with therapeutic aspirin. Six days post-discharge, she developed fatal visceral malperfusion syndrome secondary to superior mesenteric artery thrombosis originating from false lumen occlusion.

CONCLUSIONS

FET implantation in ATAAD patients with false lumen perfusion may precipitate catastrophic thrombosis despite antiplatelet. Surgical strategy selection between traditional elephant trunk and FET techniques must rigorously evaluate individual anatomy and perfusion patterns.