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Harky et al. Vessel Plus 2021;5:25 Vessel Plus
DOI: 10.20517/2574-1209.2021.26

Letter to Editor Open Access

Frozen elephant trunk: an option for everyone?

Amer Harky, Ahmed Othman, Mark Field

Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool L1, UK.
Correspondence to: Prof. Mark Field, Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Thomas drive
L14 3PE, Liverpool L1, UK. E-mail: mark.field@lhch.nhs.uk

How to cite this article: Harky A, Othman A, Field M. Frozen elephant trunk: an option for everyone? Vessel Plus 2021;5:25.
https://dx.doi.org/10.20517/2574-1209.2021.26
Received: 10 Feb 2021 Accepted: 12 Apr 2021 Published: 14 May 2021

Academic Editor: Cristiano Spadaccio Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen
Keywords: Aorta, frozen elephant trunk, patient, outcome

Dear Editor,

[1]
We read with interest the recent article by Di Marco et al. in which they have outlined their experience
with using frozen elephant trunk (FET) in different pathologies of the thoracic aorta. They briefly described
their practice since 2007 in over 318 procedures using the two commonly available conduit types: n = 173
using E-Vita Open and E-Vita Open Plus (Jotec GmbH, Hechingen, Germany) and n = 145 using Thoraflex
(Vascutek, Terumo, Inchinnan, Scotland, UK). The majority of their patients that needed FET were those
with residual dissection in operated acute type A aortic dissection (37%, n = 119) followed by those with
chronic degenerative aortic aneurysms (26%, n = 82). A further endovascular extension was performed in 85
patients due to incomplete thrombosis of the false lumen and to less extent, inadequate distal sealing. Their
idea and recommendation of a graft length of 100 mm for acute dissection and 130-160 mm for chronic
aneurysms of thoracic aorta can contribute to minimizing the risk of post-operative neurological
complications, in particular spinal cord ischaemia due to shorter length of cover of the descending thoracic
aorta.

Since the early days of conventional elephant trunk (CET) surgery in 1983 and subsequently the
development of FET during 2003, outcomes have been gradually improving including mortality and the fate
[2,3]
of the false lumen . Yet, the evidence evolves in utilizing FET and in particular the risk of paraplegia and
false lumen thrombosis with further research coming into light. Di Marco et al. had a 26.6% (n = 85) rate
[1]

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
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