Non-anatomical implantation of supra-aortic branches for customizing the standard form of Thoraflex™ hybrid prosthesis to a patient's anatomical requirements.

Frozen elephant trunk technique represents a valuable therapeutic option for patients with extensive pathology of thoracic aorta. Thoraflex™ hybrid prosthesis (Vascutek, Terumo, Inchinnan, UK) is one of the commercially available devices in which a stent graft is combined with branched vascular tube mimicking the aortic arch anatomy. Owing to the sewing collar between the stented and unstented portions, this hybrid prosthesis offers a valuable addition to the surgical armamentarium for patients with huge thoracic aorta aneurysms, in whom the aortic diameter exceeds the diameter of available stent grafts. However, the standard factory form of the quadrifurcated arch prosthesis does not always fit to the patient's anatomy and demands a deviation from the anatomical anastomosing of the branches with the respective supra-aortic arteries. A technique of non-anatomical implantation of supra-aortic arteries for customizing the standard form of the Thoraflex prosthesis is described, which facilitates the surgery without limiting the functionality of this hybrid prosthesis.