# Aortic Arch Incision and Closure Technique (AICT) for Proximal Fixation of the Frozen Elephant Trunk

## TL;DR

A new surgical technique for aortic repair using a frozen elephant trunk is described, with promising early outcomes and minimal complications.

## Contribution

A novel aortic arch incision and closure technique for proximal fixation of frozen elephant trunks is introduced and evaluated.

## Key findings

- No ischemic complications, stroke, or organ failure occurred in patients using the AICT technique.
- One patient died of pneumonia, and no proximal endoleak was observed at median 29 months follow-up.
- Cervical branch reconstruction was needed in 80% of patients, but some were treated without debranching.

## Abstract

Background: To describe an aortic arch incision and closure technique (AICT) for proximal fixation of a frozen elephant trunk (FET) and to report early outcomes. Methods: We retrospectively reviewed 15 consecutive patients who underwent distal arch repair with an FET using AICT (mean age 77 ± 7 years; 14 men). Indications were distal arch aneurysm (n = 12), acute Stanford type B dissection (n = 2), and distal arch enlargement after thoracic endovascular aortic repair (n = 1). Under circulatory arrest, an oblique arch aortotomy was created, the FET was deployed antegrade, trimmed, and sutured to the native aortic wall during simultaneous closure, allowing extended posterior fixation. Clinical outcomes and postoperative computed tomography were assessed. Results: No ischemic complications related to graft kinking or thrombosis, reoperation for bleeding, stroke, spinal cord ischemia, or organ failure occurred. One patient died of pneumonia on postoperative day 47 (6.7%). Cervical branch reconstruction was required in 12 patients (80%), whereas two patients with type III arch morphology and acute angulation were treated without debranching via a Zone 3 aortotomy. At a median follow-up of 29 months, no proximal endoleak was observed; one distal endoleak occurred without reintervention. Coronary bypass grafts remained patent in all patients with concomitant or prior CABG. Conclusions: AICT provided secure proximal FET fixation and arch closure while preserving the ascending aorta, offering an alternative to total arch replacement in selected distal arch pathologies.