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Yamanaka et al. Vessel Plus 2020;4:39 I http://dx.doi.org/10.20517/2574-1209.2020.46 Page 3 of 8

Table 1. Preoperative patient characteristics
Number 40
Age 77.0 ± 6.0 years (59-87)
Male 35 (87.5%)
Type of aneurysms
Fusiform distal aneurysm 21 (52.5%)
Saccular type aneurysm 14 (35%)
The extension of aneurysm 4 (10%)
Penetrating aortic ulcer 1 (2.5)
Hypertension 32 (80.0%)
DM (insulin) 9 (22.5%)
DL 16 (34.7%)
CVD 19 (47.5%)
Renal dysfunction (Cr ≥ 1.2) 10 (25.0%)
COPD 13 (32.5%)
Precious aortic surgery 6 (15.0%)
DM: diabetes mellitus; DL: dyslipidemia; CVD: cerebrovascular disease; Cr: creatinine; COPD:
chronic obstructive pulmonary disease

Figure 1. Procedure of total arch replacement with the frozen elephant trunk technique. The frozen elephant trunk was inserted through
the transection site into the intended distal landing portion by guiding transesophageal echocardiography. We constructed the distal
anastomosis with a separated 4-branched graft and antegrade systemic circulation was restarted through the side branch of the graft.
The left common carotid artery and brachiocephalic artery were then anastomosed to their respective graft branches. After completion
of the proximal anastomosis, the aortic graft was declamped and the 8 mm graft connected to the left subclavian artery was finally
anastomosed with one branch of the graft

bilateral upper extremities under cerebral perfusion in all cases. The aortic arch was dissected transversely
between the left common carotid artery and the left subclavian artery. The FET was inserted through the
transection site into the intended distal landing portion, which was positioned up to the T8 level to prevent
spinal cord injury (SCI). We confirmed the distal end of the FET by transesophageal echocardiography
[6]
(TEE) . We constructed the distal anastomosis with a separated 4-branched graft that was reinforced with
Teflon felt strips and antegrade systemic circulation was restarted through the side branch of the aortic
arch graft and the patient was rewarmed by extracorporeal circulation. The left common carotid artery and
brachiocephalic artery were then anastomosed to their respective graft branches. After completion of the
proximal anastomosis, the aortic graft was declamped and the 8mm graft connected to the left subclavian
artery was finally anastomosed with one branch of the arch graft [Figures 1 and 2].

Statistical analysis
Continuous variables are expressed as the mean ± standard deviation. The Kaplan-Meier method was used
to estimate mid-term outcome. Statview for Windows, version 5.0 (SAS Institute Inc., Cary, NC), was used
for the statistical analyses. Data were presented as mean ± SD, as appropriate.