Acute type A dissection with iliofemoral or renal malperfusion: Is frozen elephant trunk necessary?

Abstract

Frozen elephant trunk (FET) is being increasingly used for acute type A aortic dissection (ATAAD) with distal malperfusion. The efficacy of adding a stent graft remains unclear, however. This study investigated the efficacy of adding FET to conventional arch repair when treating ATAAD with iliofemoral or renal malperfusion. A review of the Emory Aortic Database identified 969 patients with acute DeBakey 1 dissection from 2004 to February 2025. One hundred fifty-three patients with iliofemoral and/or renal malperfusion underwent emergent central aortic repair alone (conventional group; n = 102) or central repair plus FET (FET group; n = 51). Univariate statistics were used to compare the 2 groups. Multivariable logistic regression was used to examine factors associated with postoperative limb revascularization and new renal failure. Selection bias was addressed through inverse-probability treatment weighting adjustment. Age and preoperative comorbidities were equivalent in the 2 groups. Limb ischemia requiring revascularization (17.6% for conventional vs 15.7% for FET; P = .856), or new dialysis (21.6% for conventional vs 17.6% for FET; P = .547) also was similar between the groups. Multivariable regression did not identify FET as independently associated with a reduced need for limb revascularization in iliofemoral malperfusion patients (odds ratio [OR], 1.334; 95% confidence interval [CI], 0.434-4.098; P = .614) or with avoiding dialysis in renal malperfusion patients (OR, 1.166; 95% CI, 0.252-5.382; P = .844). Mid-term survival (71.1% for conventional 71.1% vs 75.5% for FET; log-rank P = .753) and distal reintervention-free survival (64.9% for conventional vs 69.4% for FET; log-rank P = .902) were equivalent. The addition of FET to conventional repair did not impact limb revascularization, new dialysis, or mid-term reintervention or improve mid-term survival in ATAAD with iliofemoral or renal malperfusion.