Transfemoral stent-graft placement to treat a complication of the frozen elephant trunk procedure

J Endovasc Ther. 2007 Apr;14(2):260-3. doi: 10.1177/152660280701400220.

Abstract

Purpose: To report a novel complication of a hybrid "frozen elephant trunk" endograft used in the treatment of a multisegmentally diseased aorta.

Case report: A 53-year-old man with chronic type A aortic dissection and previous replacement of the supracoronary ascending aorta underwent a "frozen elephant trunk" procedure using a hybrid endograft. The stent-graft was placed deep in the descending aorta to cover the multiple distal re-entries. Due to ineffective covering of the re-entries, a patent false lumen led to rapid repressurization of the false lumen immediately distal to the circumferential elephant trunk anastomosis. Compression of the non-stented portion of the hybrid endograft caused a functional aortic stenosis, with severe hemodynamic consequences. Endovascular treatment of the compression by retrograde transfemoral placement of a stent-graft in the non-stented portion of the hybrid endograft achieved free flow in the distal aorta.

Conclusion: This case documents a new complication of the frozen elephant trunk procedure; a pseudocoarctation from a repressurized proximal false lumen was successfully managed with a stent-graft to support the non-stented segment of the hybrid endograft.

Publication types

  • Case Reports

MeSH terms

  • Aorta, Thoracic / diagnostic imaging
  • Aorta, Thoracic / physiopathology
  • Aorta, Thoracic / surgery*
  • Aortic Aneurysm, Thoracic / diagnostic imaging
  • Aortic Aneurysm, Thoracic / surgery*
  • Aortic Dissection / diagnostic imaging
  • Aortic Dissection / surgery*
  • Aortography
  • Arterial Occlusive Diseases / diagnostic imaging
  • Arterial Occlusive Diseases / etiology
  • Arterial Occlusive Diseases / physiopathology
  • Arterial Occlusive Diseases / surgery*
  • Blood Vessel Prosthesis Implantation / adverse effects*
  • Blood Vessel Prosthesis*
  • Chronic Disease
  • Constriction, Pathologic / etiology
  • Constriction, Pathologic / surgery
  • Femoral Artery / diagnostic imaging
  • Femoral Artery / surgery*
  • Humans
  • Male
  • Middle Aged
  • Prosthesis Design
  • Radiography, Interventional
  • Regional Blood Flow
  • Stents*
  • Treatment Outcome