Work

Fatal delayed superior mesenteric artery thrombosis after frozen elephant trunk repair in acute type a aortic dissection with false lumen perfusion: a case report

Year: 2026

Type: article

Abstract: BACKGROUND: Frozen elephant trunk (FET) implantation is an established technique for acute Type A aortic dissection (ATAAD), promoting true lumen expansion and aortic remodeling. However, in patients with preoperative false lumen perfusion, FET carries a significant risk of postoperative false lumen thrombosis that may acutely obstruct branch vessel flow and trigger malperfusion syndrome. CASE PRESENTATION: A 74-year-old hypertensive female presented with acute chest pain. Computed tomography angiography confirmed ATAAD with false lumen perfusion supplying all visceral arteries. Emergency ascending aorta replacement, total arch replacement, and FET implantation were performed. The patient was discharged on postoperative day twelve with therapeutic aspirin. Six days post-discharge, she developed fatal visceral malperfusion syndrome secondary to superior mesenteric artery thrombosis originating from false lumen occlusion. CONCLUSIONS: FET implantation in ATAAD patients with false lumen perfusion may precipitate catastrophic thrombosis despite antiplatelet. Surgical strategy selection between traditional elephant trunk and FET techniques must rigorously evaluate individual anatomy and perfusion patterns.

Source: Journal of Cardiothoracic Surgery

DOI: 10.1186/s13019-025-03812-0

Authors: Huai-Yu Zhao, Li-Xi Gan, Hong-Wei Guo

Institutions: Chinese Academy of Medical Sciences & Peking Union Medical College, Fu Wai Hospital, State Key Laboratory of Cardiovascular Disease

Language: English

Topic: Aortic Disease and Treatment Approaches

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,890