Secondary TEVAR After Frozen Elephant Trunk: Indications and Timing
8 affiliations
- 1Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USA
- 2NYU Grossman School of Medicine, NYU Langone Health, New York, NY 10016, USA
- 3Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
- 4Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece
- 5Department of Cardiothoracic Surgery, Jena University Hospital, 07747 Jena, Germany
- 6Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Via Bissolati 57, 25124 Brescia, Italy
- 7Department of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY 10075, USA
- 8Department of Medicine, Surgery and Dentistry, University of Salerno, Via Giovanni Paolo II 132, 84084 Salerno, Italy
Abstract
Frozen elephant trunk (FET) stabilizes the arch and proximal descending aorta, but complete distal remodeling is achieved in only a subset of patients with aortic dissection. Persistent false lumen perfusion, aortic growth, and distal stent graft-induced new entry lead to secondary thoracic endovascular aortic repair (TEVAR), and reported distal reintervention rates range from about 13% at 5 years in pooled data to 33% in a center with routine staging. This narrative review examines the indications for and timing of secondary TEVAR after FET. PubMed was searched to September 2026, and 97 publications were included. Evidence obtained in patients treated with FET is distinguished from evidence extrapolated from primary type B dissection and from the authors’ interpretation. We summarize the predictors of incomplete remodeling, including stent graft length, residual re-entry location, chronicity, aortic diameter at the distal stent level, early remodeling trajectory, and heritable aortopathy, and we contrast planned completion with surveillance-based reactive TEVAR, including technical aspects and spinal cord protection. Direct evidence on timing after FET is limited to retrospective series and one pilot randomized trial of TEVAR 1 to 3 months after type I repair; most data on the time-dependent loss of flap plasticity come from primary type B dissection. No universal timing rule is supported. We propose a phenotype-driven approach, not yet validated, in which timing is referenced to dissection onset and individualized to aortic anatomy, disease progression, and clinical condition.
Related
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- Situs Inversus Totalis with Mirror-Image Dextrocardia and Acute Type A Aortic Dissection Treated by Ascending Aorta Replacement Plus Total Arch Replacement and Frozen Elephant Trunk Using an Inverted Four-Branched Graft: A Case Report
BibTeX
@article{magouliotis2026secondary,
title = {{Secondary TEVAR After Frozen Elephant Trunk: Indications and Timing}},
author = {Dimitrios E. Magouliotis and Beatrice Bacchi and Arian Arjomandi Rad and Andrew Xanthopoulos and Tulio Caldonazo and Michele D’Alonzo and Massimo Baudo and Francesco Cabrucci and Francesca Maria di Muro},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218585},
url = {https://www.mdpi.com/2077-0383/15/21/8585},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Secondary TEVAR After Frozen Elephant Trunk: Indications and Timing
AU - Dimitrios E. Magouliotis
AU - Beatrice Bacchi
AU - Arian Arjomandi Rad
AU - Andrew Xanthopoulos
AU - Tulio Caldonazo
AU - Michele D’Alonzo
AU - Massimo Baudo
AU - Francesco Cabrucci
AU - Francesca Maria di Muro
PY - 2026
DA - 2026/11/04
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218585
UR - https://www.mdpi.com/2077-0383/15/21/8585
AB - Frozen elephant trunk (FET) stabilizes the arch and proximal descending aorta, but complete distal remodeling is achieved in only a subset of patients with aortic dissection. Persistent false lumen perfusion, aortic growth, and distal stent graft-induced new entry lead to secondary thoracic endovascular aortic repair (TEVAR), and reported distal reintervention rates range from about 13% at 5 years in pooled data to 33% in a center with routine staging. This narrative review examines the indications for and timing of secondary TEVAR after FET. PubMed was searched to September 2026, and 97 publications were included. Evidence obtained in patients treated with FET is distinguished from evidence extrapolated from primary type B dissection and from the authors’ interpretation. We summarize the predictors of incomplete remodeling, including stent graft length, residual re-entry location, chronicity, aortic diameter at the distal stent level, early remodeling trajectory, and heritable aortopathy, and we contrast planned completion with surveillance-based reactive TEVAR, including technical aspects and spinal cord protection. Direct evidence on timing after FET is limited to retrospective series and one pilot randomized trial of TEVAR 1 to 3 months after type I repair; most data on the time-dependent loss of flap plasticity come from primary type B dissection. No universal timing rule is supported. We propose a phenotype-driven approach, not yet validated, in which timing is referenced to dissection onset and individualized to aortic anatomy, disease progression, and clinical condition.
SN - 2077-0383
ER -