Fenestrated and covered frozen elephant trunk technique for management of chronic aortic dissection.

BACKGROUND

Reintervention for residual dissection after repaired type A aortic dissection remains challenging. When a frozen elephant trunk (FET) is used, the incidence of distal stent graft-induced new entry (d-SINE) is reportedly high in chronic dissection.

AIMS: We report a case of successful redo arch repair using fenestrated and covered FET techniques for chronic residual aortic dissection.

METHODS

After the arch was transected proximal to the left subclavian artery (LSCA), and a modified FET prosthesis, in which the distal edge of the FET was covered, was deployed. A fenestration was created in the FET on the LSCA aspect.

RESULTS

The postoperative course was uneventful.

DISCUSSION: The distal edge of the FET was covered to prevent d-SINE. Creation of a fenestration on the FET eliminates the need to reconstruct the LSCA.

CONCLUSION

The fenestrated FET technique simplifies redo arch repair and the covered FET technique can potentially prevent d-SINE.