“Proximalization is Advancement”—Zone 3 Frozen Elephant Trunk vs Zone 2 Frozen Elephant Trunk: A Literature Review

2021 ◽  
pp. 153857442110024
Author(s):  
Rozina Yasmin Choudhury ◽  
Kamran Basharat ◽  
Syeda Anum Zahra ◽  
Tien Tran ◽  
Lara Rimmer ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Treatment ◽  
Literature Review ◽  
Treatment Options ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Cord Injury ◽  
Aortic Pathologies

Over the decades, the Frozen Elephant Trunk (FET) technique has gained immense popularity allowing simplified treatment of complex aortic pathologies. FET is frequently used to treat aortic conditions involving the distal aortic arch and the proximal descending aorta in a single stage. Surgical preference has recently changed from FET procedures being performed at Zone 3 to Zone 2. There are several advantages of Zone 2 FET over Zone 3 FET including reduction in spinal cord injury, visceral ischemia, neurological and cardiovascular sequelae. In addition, Zone 2 FET is a technically less complicated procedure. Literature on the comparison between Zone 3 and Zone 2 FET is scarce and primarily observational and anecdotal. Therefore, further research is warranted in this paradigm to substantiate current surgical treatment options for complex aortic pathologies. In this review, we explore literature surrounding FET and the reasons for the shift in surgical preference from Zone 3 to Zone 2.

scholarly journals The risk of spinal cord injury during the frozen elephant trunk procedure in acute aortic dissection

2018 ◽  
Vol 26 (6) ◽  
pp. 972-976 ◽  
Author(s):  
Boris N Kozlov ◽  
Dmitri S Panfilov ◽  
Igor V Ponomarenko ◽  
Andrey G Miroshnichenko ◽  
Aleksandra A Nenakhova ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Cord Injury ◽  
Elephant Trunk Procedure

scholarly journals Successful surgical treatment of intracardiac bone cement embolism after vertebroplasty of the L2 vertebral body

2020 ◽  
Vol 8 (4S) ◽  
pp. 130-134
Author(s):  
N. I. Zagorodnikov ◽  
I. K. Halivopulo ◽  
A. V. Sotnikov ◽  
E. I. Ardasheva
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Treatment ◽  
Bone Cement ◽  
Vertebral Body ◽  
Percutaneous Vertebroplasty ◽  
Treatment Options ◽  
Cord Injury ◽  
Cement Embolism ◽  
Bone Cement Embolism

Percutaneous Vertebroplasty (PVP) is the minimally invasive radiological procedure consisting in the transdermal injection of bone cement into the damaged vertebral body. PVP performing has a high risk of complications including vascular embolism which has value from 3.5 to 30 %. There is an example of cardioembolism with bone cement as a result of PVP complication after surgical treatment of a patient with a spinal cord injury after ancar accident and the successful extraction of this embolus is given in this clinical case.The authors describe the approaches to this problem, including the diagnosis of the condition and treatment options.

scholarly journals Early and mid-term outcome of frozen elephant trunk using spinal cord protective perfusion strategy for acute type A aortic dissection

2020 ◽  
Vol 68 (10) ◽  
pp. 1119-1127
Author(s):  
Yu Hohri ◽  
Takuma Yamasaki ◽  
Yuichi Matsuzaki ◽  
Takeshi Hiramatsu
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Cord Injury ◽  
Spinal Cord Protection

Abstract Objective This study aimed to evaluate the prevalence of spinal cord injury in total arch replacement with frozen elephant trunk for acute type A aortic dissection using our spinal cord protection technique. Methods Between January 2013 and December 2017, 33 patients underwent total arch replacement with frozen elephant trunk for acute type A aortic dissection (mean age 67.9 ± 13.3 years). Our spinal cord protection technique involved maintaining extracorporeal circulation through the left subclavian artery in all procedures, using aortic occlusion balloon during distal anastomosis, and inserting frozen elephant trunk above Th 8 with transesophageal echocardiographic guidance. Computed tomography was performed within 1–2 weeks, 12 months, and 36 months postoperatively. We compared the degree of thrombosis of the descending aorta between preoperation and early postoperative period by Fisher’s exact test. Moreover, we evaluated postoperative mortality and mobility (including spinal cord injury) at follow-up. Results The operative mortality within 30 days was 6.1%. Neither paraplegia nor paraparesis was noted. We observed significant thrombosis of the false lumen at the distal arch and aortic valve level of the descending aorta in postoperative early term period (p < 0.01). At mid-term follow-up (mean 33.9 months), survival probability and 3-year freedom from reoperation rates were 93.9 ± 4.1% and 95.0 ± 4.9%, respectively. Conclusions The frozen elephant trunk technique with our spinal protection strategy provides good postoperative outcomes. Our strategy can maintain spinal cord perfusion without complete ischemia time even during lower body ischemia time. Implementation of our spinal protection strategy will help prevent spinal cord injury and dilated downstream aorta.

scholarly journals Surgical treatment of spinal thoracic metastases with nerve injury in patients with moderate-to-severe spinal cord injury

2020 ◽  
Vol 9 (5) ◽  
pp. 3204-3212
Author(s):  
Chao Xue ◽  
Peng Ren ◽  
Dongliang Liang ◽  
Mingyu Yang ◽  
Ning Lu
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Treatment ◽  
Nerve Injury ◽  
Cord Injury
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