Incidence and Outcomes of Intraluminal Frozen Elephant Trunk Stent Graft Thrombosis After Aortic Arch Surgery: Systematic Review and Meta-Analysis.

BACKGROUND

Intraluminal thrombosis (ILT) has been observed in endografts in the thoracic aorta after frozen elephant trunk (FET) for aortic arch pathologies. This study aimed to evaluate the incidence and clinical outcomes associated with ILT.

METHODS

Systematic review of studies reporting incidence of ILT after FET and comparing outcomes of patients with and without ILT. PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane databases (inception to September 2025) were searched. Single-arm meta-analysis was conducted to determine ILT incidence and 2-arm meta-analyses between groups with ILT and without with a random-effects model to assess patient-relevant outcomes.

RESULTS

Five observational studies, including 999 patients, met our eligibility criteria. Pooled incidence of ILT after FET was 9.24% (95% CI, 6.32-13.31). Although we did not find statistically significant associations between ILT and postoperative stroke (odds ratio [OR], 0.93 [95% CI, 0.46-1.88]; P=0.845), we found statistically significant associations with embolic events (OR, 6.94 [95% CI, 1.01-47.46]; P=0.048) and early mortality (OR, 3.59 [95% CI, 1.69-7.60]; P<0.001). We found positive correlations between proportion of female patients in the populations and incidence of ILT (coefficient, 0.08 [95% CI, 0.02-0.14]; P=0.011). Meta-regression coefficients were statistically significant for embolic events and female sex (coefficient, 0.12 [95% CI, 0.06-0.18]; P<0.001), aortic aneurysm (coefficient, 0.08 [95% CI, 0.04-0.13]; P<0.001), and mean age (coefficient, 0.66 [95% CI, 0.33-0.99]; P<0.001), which means that associations differ across populations with varying mean levels of these covariates.

CONCLUSIONS

Because ILT after FET seems to be associated with embolic events and early mortality, close follow-up is warranted-especially for women, older people, and patients with aortic aneurysms-and anticoagulation should be considered.