Sizing the Frozen Elephant Trunk Based on Aortic Pathology and the Importance of Pre-Operative Imaging

The frozen elephant trunk is a formidable tool for the aortovascular surgeon. An appreciation of how to size the graft in different pathologies is key in achieving optimal results. Herein, we demonstrate worked examples of how imaging can be used to plan for a frozen elephant trunk and discuss the nuisances and uncertainties of sizing using three index cases: Type A aortic dissection, distal thoracic aortic aneurysm and chronic dissection.

Frozen elephant trunk for blunt aortic arch injury

Total arch replacement with the frozen elephant trunk technique is expanding its indications to treat a wide range of aortic arch and descending aortic conditions. Although blunt thoracic aortic injury commonly occurs at the aortic isthmus or descending thoracic aorta, we encountered a 36-year-old male patient with Grade III blunt aortic injury located in the mid-arch. An endovascular approach was not feasible and thus the patient underwent total arch replacement using the frozen elephant trunk technique.