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Di Marco et al. Vessel Plus 2020;4:32 I http://dx.doi.org/10.20517/2574-1209.2020.23 Page 3 of 7

Figure 2. Frozen elephant trunk procedure with E-Vita Open plus prosthesis in a case of acute type A aortic dissection with the
progressive thrombosis and shrinkage of the false lumen after 1 week (A), after 3 months (B) and after 2 years with almost complete
aortic remodeling (C)

dissection (not undergone surgery) in 25 patients, and acute and chronic type B aortic dissection in 13
and 35 patients, respectively. Combined procedures were 128 (40.3%). With a mean follow up of 5 years,
endoprosthetic extensions were performed in 85 patients (45 in E-Vita Open group and 40 in the Thoraflex
group). In the vast majority of cases, the indication for extension was the incomplete thrombosis of the
false lumen, whilst in very few cases, it was the inadequate distal sealing.

Some crucial recommendations we learnt from our experience are: accurate pre-operative assessment of
the entire aortic anatomy, with identification of intimal tear and re-entry tears and visceral arteries origin
from the true or false lumen in aortic dissections, careful evaluation of aortic diameters for appropriate
graft sizing, and employment of safe and reliable organ protection and surgical strategies. In acute aortic
dissection, oversizing is contraindicated since it can produce stent-induced new entry tears. Conversely, in
chronic degenerative aortic aneurysms, oversizing allows an optimal distal graft sealing and it is therefore
indicated.

Surgical technique
At our institution, the surgical technique for FET procedure is standardized to allow reproducibility and
better outcomes. Following a full median sternotomy and administration of heparin, a stiff guide-wire is