Editorial comment regarding "Total aortic arch replacement using the frozen elephant trunk technique with J Graft Open Stent Graft for distal aortic arch aneurysm".

Total aortic arch replacement using the frozen elephant trunk (FET) technique has gained worldwide popularity, because it has simplified the treatment of complicated thoracic aortic lesions. The most effective use of FET has been total arch repair for acute-type A aortic dissection because of its particularly favorable prognosis. However, the use rate for true aneurysm in 2016 was half of the total 2150 cases using FET. The widespread use of FET is attributable to its ease of use. The incidence of FET-related paraplegia has decreased with the use of total aortic arch replacement but is still higher than in classic total arch replacement with distal arch anastomosis. A prospective multicenter study for FET is necessary.