Geragotellis Alexander, Jubouri Matti, Al-Tawil Mohammed, Mohammed Idhrees, Bashir Mohamad, Hosseini Saeid
Faculty of Health Sciences, University of Cape Town, Observatory, South Africa.
Hull York Medical School, University of York, York.
Aorta (Stamford). 2023 Dec;11(6):174-190. doi: 10.1055/s-0044-1786352. Epub 2024 May 16.
Conventional elephant trunk (cET) and frozen elephant trunk (FET) are two distinct approaches to the surgical treatment of thoracic aortic aneurysms and dissections. With the advent and growing uptake of endovascular technologies, FET is becoming increasingly popular for its potential to be performed as a single-stage operation with better aortic remodeling and less risk of graft kinking than the traditional two-stage cET procedure. However, FET has been associated with a higher risk of spinal cord ischemia and its use in patients with connective tissue disorder remains controversial. The current review aimed to reflect on recent evidence surrounding the application of cET and FET to different types of aortic pathology in both acute and elective settings. Another scope of this review was to compare the characteristics of the currently available FET commercial devices on the global market. Our findings highlight that when the pathology is confined to the proximal descending aorta, such as in Dsine, intervention is often single-staged and false lumen (FL) thrombosis is achieved with good effect. FET remains limited by spinal cord injury and applicability in patients with connective tissue disorder, although some groups have started to circumvent associated complications, likely due to growing surgical expertise. Many other aortic diseases do require second-stage intervention, and even in these cases, there appears to be lower in-hospital mortality when using FET over cET. This is possibly due to the higher rate of endovascular completion facilitated by the completed landing zones created during FET. FET is trending toward becoming the universal treatment modality for extending repair to the descending aorta.
传统象鼻术（cET）和冰冻象鼻术（FET）是胸主动脉瘤和夹层手术治疗的两种不同方法。随着血管内技术的出现和应用增加，FET因其有可能作为单阶段手术进行，与传统的两阶段cET手术相比，能实现更好的主动脉重塑且移植物扭结风险更低，而越来越受欢迎。然而，FET与脊髓缺血风险较高相关，其在结缔组织疾病患者中的应用仍存在争议。本综述旨在反思围绕cET和FET在急性和择期情况下应用于不同类型主动脉病变的最新证据。本综述的另一个范围是比较全球市场上目前可用的FET商业设备的特点。我们的研究结果表明，当病变局限于降主动脉近端时，如在Dsine中，干预通常为单阶段，假腔（FL）血栓形成效果良好。FET仍然受到脊髓损伤和在结缔组织疾病患者中适用性的限制，尽管一些团队已经开始规避相关并发症，这可能是由于外科专业知识的增加。许多其他主动脉疾病确实需要二期干预，即使在这些情况下，与cET相比，使用FET时院内死亡率似乎更低。这可能是由于FET期间创建的完整着陆区促进了血管内完成率的提高。FET正趋向于成为将修复扩展至降主动脉的通用治疗方式。
