Which Frozen Elephant Trunk offers the optimal solution? Reflections from Essen Group.

Frozen Elephant Trunk (FET) represents an evolution of the treatment of extensive aortic arch disease in the last two decades [1]. The combination of a self-expandable nitinol supported stent graft for the endovascular treatment of the descending aorta with a vascular graft for the aortic arch replacement allowed: First, the extension of the arch replacement into the descending aorta and second, the performance of this treatment with a single (combined) graft. Thus, the treatment of the descending aorta became possible in one stage through a median sternotomy without resection of the descending aorta pathology and without a surgical suture in the anatomically challenging left upper thoracic cavity [2]. In contrast to the endovascular treatment by a classic stent graft, the fixation of FET proximally is achieved by a surgical circumferential hemostatic suture, which eliminates the risk of proximal endoleak without sealing- and landing zone related restrictions.