Introduction
Both acute and chronic aortic pathologies are often associated with
descending aorta disease. The Frozen Elephant Trunk (FET) hybrid
procedure has developed to treat both segments, sometimes with a
definitive aortic reconstruction in one stage or in anticipation of
subsequent completion with thoracic endovascular repair (TEVAR).
Thoraflex™ Hybrid (Terumo Aortic) is a dedicated FET device that joins a
distal endovascular nitinol ringed stent-graft with a proximal
4-branched surgical graft and has been used in acute and chronic
settings to reduce circulatory arrest time and improve cerebral and
systemic perfusion.1 We have implanted over 70
Thoraflex Hybrid devices and been challenged by reimplantation of the
supra-aortic trunk (SAT) vessels, expecially the left carotid (LCA) and
left subclavian (LSA) arteries, their chest positioning, and management
of cerebral perfusion. To address this, we requested a custom-made
configuration and describe here the first experience.