Covering Anastomosis to Frozen Elephant Trunk in Secondary Downstream Aorta Replacement.

There has been an increasing number of secondary downstream aorta replacements following aortic arch repair using a frozen elephant trunk (FET). We present an anastomosis technique to join a frozen elephant graft to a downstream prosthetic graft. The FET is inserted into the downstream graft with continuous sutures, with a two-bite Dacron graft added to the frozen elephant side. This technique may prevent anastomotic leakage between two grafts.