Use of a Novel Physician-Modified Frozen Elephant Trunk to Manage an Acute Aortic Arch Aneurysm

Background: The frozen elephant trunk (FET) technique has become a cornerstone in managing complex aortic arch disease. However, commercial FET systems may be unavailable in emergent situations, necessitating alternative solutions. First-in-Human/Early Reports Summary: In a 57-year-old man with an acute arch aneurysm with dissection, we replicated the FET configuration by back-table modification of a standard thoracic stent graft and combining it with a surgical graft. This novel approach, the “C-tag Endograft SanRaffaele Arrangement to Re-create a frozen Elephant trunk” (CESARE), provides a rapid, adaptable solution for emergent aortic arch repair with FET when commercial devices are unavailable. Discussion: The modified device was prepared in 65 minutes and was deployed under moderate hypothermic circulatory arrest, with uneventful recovery and excellent early imaging. Novelty: CESARE is a rapid, customizable, and widely accessible alternative to FET. Take-Home Message: This technique enables effective arch repair when standard FET prostheses are unavailable.