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This case report describes a hybrid aortic arch reconstruction in a 60-year-old patient with chronic type B aortic dissection and aneurysmal degeneration. The procedure involved a "double-barrel" frozen elephant trunk technique combined with thoracic endovascular aortic repair (TEVAR) to address a complex dissection with a poor endovascular landing zone. The technique aimed to maintain true and false lumen flow while excluding the arch pseudoaneurysm.
The double-barrel frozen elephant trunk technique offers a potential surgical solution for complex chronic aortic dissections where endovascular options are limited.
We present a complex aortic reconstruction for a 60-year-old patient presented with chronic type B aortic dissection, with a large proximal entry tear in zone 3, aneurysmal degeneration in the distal arch, and a small true lumen with a calcified septum. Endovascular options were limited by a poor proximal landing zone, difficulty excluding the arch pseudoaneurysm while maintaining true and false lumen flow, lack of septal fenestrations, and a calcified septum. Open extent 2 thoracoabdominal repair carried a significantly higher risk compared with sternotomy and ascending aortic and arch replacement due to the patient size and underlying chronic obstructive pulmonary disease. The patient was not tested for connective tissue disease given age, comorbid conditions, absence of a family history of aortopathy, and no stigmata of connective tissue disease. We describe a hybrid arch reconstruction with “double-barrel” frozen elephant trunks and extension thoracic endovascular aortic repair to address a complex chronic aortic dissection. This technique may be useful in select cases of complex aortic dissection.
