Abstract
Aortic arch replacement operations have undergone substantial evolution with technical advancements, notably the introduction of the frozen elephant trunk (FET) technique. The purpose of this state-of-the-art review is to detail our approach to contemporary aortic arch replacement with FET operations. First, we review the evolution of FET procedures over the years and discuss technical modifications, including cerebral perfusion options, to the aortic arch replacement with FET. We also discuss state-of-the-art technical considerations of head vessel reconstruction and management of the difficult left subclavian artery. We also discuss selected considerations related to the endovascular stent graft component, including landing zone management and when to consider extended distal aortic interventions. We briefly discuss potential complications of which the vigilant clinician should be aware, as well as highlight subtleties in managing aortic dissection compared with aortic aneurysms.