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Di Marco et al. Vessel Plus 2020;4:32 Vessel Plus
DOI: 10.20517/2574-1209.2020.23

Perspective Open Access

Frozen elephant trunk: assets and liabilities of a
challenging technique

Luca Di Marco, Daniela Votano, Alessandro Leone, Davide Pacini

Cardiac Surgery Unit, Cardio-Thoracic-Vascular Dept., Sant’Orsola Hospital, Bologna University, Bologna 40138, Italy.
Correspondence to: Dr. Luca Di Marco, Cardiac Surgery Unit, Cardio-Thoracic-Vascular Dept. Sant’Orsola Hospital, via
Massarenti 9, Bologna University, Bologna 40138, Italy. E-mail: ludima08@libero.it

How to cite this article: Di Marco L, Votano D, Leone A, Pacini D. Frozen elephant trunk: assets and liabilities of a challenging
technique. Vessel Plus 2020;4:32. http://dx.doi.org/10.20517/2574-1209.2020.23

Received: 1 Jun 2020 First Decision: 15 Jun 2020 Revised: 14 Jul 2020 Accepted: 10 Oct 2020 Published: 21 Oct 2020

Academic Editor: Cristiano Spadaccio Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
The development of the frozen elephant trunk (FET) technique for a simplified treatment of complex lesions of
Received: First Decision: Revised: Accepted: Published: x the thoracic aorta originated as an evolution of the classic elephant trunk technique, described for the first time
[1]
by Borst et al. in 1983. Novel technologies and standardization of the surgical approach produced a progressive
Science Editor: Copy Editor: Production Editor: Jing Yu
improvement of early and late outcomes. Most of the time and for specific indications, FET procedure allows
physicians to treat lesions involving extensive portions of the thoracic aorta in one single step. Spinal cord injury
remains one of the main complications of this procedure, even though spinal protection strategies have led to
better results. We hereby report our opinions and recommendations based on our experience started in 2007.

Keywords: Aortic arch, acute aortic dissection, frozen elephant trunk procedure, chronic aneurysm

INTRODUCTION
Complex thoracic aortic lesions represent one of the most relevant challenges in cardiovascular surgery,
often requiring more surgical and/or endovascular procedures than other diseases/injuries in the
field. Since the introduction of the “Elephant Trunk” (ET) technique, described in 1983 by Borst and
[1]
colleagues as a two-stage approach , methods and skills have been rapidly evolving with the introduction
of innovative materials and more standardized techniques [2-4] . This progression eventually led to the
development of the frozen elephant trunk (FET) technique in 2003, thanks to the introduction of hybrid
[5]
prostheses made up of a proximal surgical tubular graft and a distal endovascular stent-graft .

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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