Randolph H. L. Wong, FRCS, Peter S. Y. Yu, MRCS, Micky W. T

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Endovascular Fenestration for Distal Aortic Sealing After Frozen Elephant Trunk With Thoraflex Randolph H.L. Wong, FRCS, Peter S.Y. Yu, MRCS, Micky W.T. Kwok, FRCS, Simon C.Y. Chow, MRCS, Jacky Y.K. Ho, MRCS, Malcolm J. Underwood, FRCS, Simon C.H. Yu, FRCR The Annals of Thoracic Surgery Volume 103, Issue 6, Pages e479-e482 (June 2017) DOI: 10.1016/j.athoracsur.2016.12.039 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Contrast computed tomographic views of the aorta with 3-dimensional image reconstruction. (A) The frozen elephant trunk was deployed into the false lumen and the aneurysm sac. (B) Exclusion of false lumen perfusion after aortic fenestration followed by thoracic endovascular aortic repair. The Annals of Thoracic Surgery 2017 103, e479-e482DOI: (10.1016/j.athoracsur.2016.12.039) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Intraoperative digital subtraction angiogram. (A) Via right femoral cannulation, the true and false lumen, and the position of the dissection flap were identified. (B) After puncture of the dissection flap, the fenestration was enlarged by snaring the microwire with Amplatz gooseneck snare passed via the left femoral artery. (C) Through the fenestration, a Terumo guidewire was passed from the true lumen into the false elephant trunk inside the false lumen. (D) Three stent grafts were deployed, diverting all the perfusion from the false elephant trunk back into the true lumen. (RF = radiofrequency.) The Annals of Thoracic Surgery 2017 103, e479-e482DOI: (10.1016/j.athoracsur.2016.12.039) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Schematic diagram showing the false elephant trunk deployed inside the false lumen. (A) Dissection flap punctured by use of the radiofrequency ablation probe. (B) Through the fenestration, stent grafts were deployed, diverting the perfusion from the false elephant trunk through the fenestration into the true lumen. The Annals of Thoracic Surgery 2017 103, e479-e482DOI: (10.1016/j.athoracsur.2016.12.039) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions