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               of requirement for further re-intervention following the deployment of FET, which is significantly high and
               these question the safety of recommending a 100 mm vs. 130-160 mm graft length in their “idea” of using
               the FET graft.


               We all know that using the FET device offers many solutions to acute and chronic pathologies of thoracic
               aorta and it has undoubtedly saved many lives. However, the FET is not a benign addition to the
               conventional elephant trunk; we believe caution should be taken in patients with borderline indication,
               where the sole purpose is an endovascular platform for distal diseases that are not requiring treatment
               immediately. Using FET in patients who are not “ideal” candidates can result in incremental and, perhaps,
               unnecessary risks of paraplegia, quadriplegia, distal stent-graft induced entry tear, endoluminal thrombosis,
                                                        [4]
               endoleaks and pressurization from false lumen . Also, the risks associated with chronic dissection flaps
               such as sizing issues and stent coarctation should not be ignored. In our opinion, careful patient selection
               with favorable anatomy and available multidisciplinary expertise is an ideal approach to minimizing the risk
               of avoidable complications at the initial procedure.


               DECLARATIONS
               Authors’ contributions
               Reviewed and approved final form of the letter to editor: Harky A, Othman A, Field M
               All authors contributed equally to this paper.

               Availability of data and materials
               Not applicable.


               Financial support and sponsorship
               None.


               Conflicts of interest
               All authors declared that there are no conflicts of interest.


               Ethical approval and consent to participate
               Not applicable.


               Consent for publication
               Not applicable.


               Copyright
               © The Author(s) 2021.


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