Total Arch Replacement and Frozen Elephant Trunk for Acute Complicated Type B Dissection.

The current management of acute complicated type B aortic dissection is a combination of medical therapy and endovascular repair. Endovascular repair is not feasible when the dissection extends into the aortic arch. We describe three patients with acute type B aortic dissection complicated by retrograde arch extension and visceral malperfusion who were successfully treated with a total arch replacement and frozen elephant trunk. In patients with acute complicated type B aortic dissection without adequate proximal landing zone, thoracic endovascular aortic repair (TEVAR) is not feasible. While some uncomplicated patients with retrograde aortic arch extension can be managed non-operatively, patients with distal malperfusion present a challenge. We describe three patients who presented with an acute type B aortic dissection with associated visceral malperfusion who were treated with total arch replacement and frozen elephant trunk (FET).