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Yamanaka et al. Vessel Plus 2020;4:39 I http://dx.doi.org/10.20517/2574-1209.2020.46 Page 7 of 8

Additionally, the FET has some attractive advantages as follows: (1) the proximalization of distal
anastomosis to zone 2; (2) the simplification of technical complexity; (3) the easy deployment of the FET;
(4) the shortening of lower body ischemic time; and (5) fixation of stented graft to avoid graft migration.
Furthermore, postoperative hoarseness can be avoided by the use of the FET because the distal anastomosis
site lies off the left recurrent nerve at the distal aortic arch. Hoarseness may induce to aspiration pneumonia
in elderly patients. The left recurrent nerve palsy was 0% in TAR with the FET (40 patients) and 5% in that
without the FET (121 patients) in our other study [13,14] . Therefore, the FET technique may better preserve
postoperative laryngeal function in elderly frail patients.

[15]
In conclusion, the FET attained the proximalization of distal anastomosis to zone 2 rather than zone 3 .
It caused decreases in incidences of cardiac arrest, selective cerebral perfusion, and visceral ischemia. It
further helped to reduce the incidence of recurrent nerve palsy, the ease of anastomosis, and control of
hemorrhage. The FET has the potential to improve TAR for distal aortic arch aneurysms.

DECLARATIONS
Authors’ contributions
Authors made substantial contributions to the conception and design of the study, and participated in
drafting the article: Yamanaka K
Authors provided administrative, technical, and material support: Iwakura A
The author participated in critical revision for important conceptual and intellectual content and gave final
approval of the version to be submitted to the Journal: Fujita M or more authors: Nishina T, Sekine Y
Performed data acquisition, as well as provided administrative, technical, and material support: Sato S,
Yada M, Tara Y

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) 2020.

REFERENCES
1. Kato M, Ohnishi K, Kaneko M, et al. New graft-implanting method for thoracic aortic aneurysm or dissection with a stented graft.
Circulation 1996;94:II188-93.
2. Mestres CA, Tsagakis K, Pacini D, et al. One-stage repair in complex multisegmental thoracic aneurysmal disease: results of a multicenter
study. Eur J Cardiothorac Surg 2013;44:e325-31.
3. Uchida N, Katayama A, Tamura K, Sutoh M, Kuraoka M, Ishihara H. Frozen elephant trunk technique and partial remodeling for acute
type A aortic dissection. Eur J Cardiothorac Surg 2011;40:1066-71.
4. Uchida N, Katayama A, Higashiue S, et al. A new device as an open stent graft for extended aortic repair: a multicentre early experience