OBJECTIVES The aim of this study was to analyse outcomes of downstream thoracic endovascular aortic repair (TEVAR) following the frozen elephant trunk (FET) procedure. METHODS Sixty-six patients underwent downstream TEVAR following the FET procedure to treat thoracic aortic dissections (n = 42, 64%), aneurysms (n = 19, 29%) or penetrating aortic ulcers involving the aortic arch (n = 5, 8%). Patient and outcome characteristics were analysed. RESULTS Downstream TEVAR was performed 7 [interquartile range: 2-18] months after the FET procedure in 39 male (59%) and 27 female (41%) patients aged 68 [interquartile range: 56, 75] years, including 11 patients (17%) with a connective tissue disease. Before TEVAR, cerebrospinal fluid drainage was put in place in 61 patients (92%). Patients were treated with 1 stent graft (n = 28, 42%), 2 stent grafts (n = 37, 56%) or 3 stent grafts (n = 1, 2%). The femoral artery was accessed through surgical cut-down (n = 15, 23%) or percutaneously (n = 49, 74%). One patient (2%) developed a temporary spinal cord injury that resolved spontaneously. No case of permanent spinal cord injury, stroke or death was observed. After 12 [interquartile range: 2-23] months, 15 patients required an additional aortic reintervention (endovascular: n = 6; surgical: n = 9). CONCLUSIONS Downstream TEVAR following the FET procedure is associated with excellent clinical outcomes. We thus maintain that staging thoracic aortic repair-FET and secondary TEVAR-is a very successful and safe strategy. Certain patients might need a tertiary procedure to fix their entire aortic pathology; therefore, they will require long-term continuous follow-up, ideally in a dedicated aortic clinic.

中文翻译：

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2 区后的下游胸腔血管内主动脉修复，100 毫米支架移植物冷冻象鼻植入。

目的 本研究的目的是分析冷冻象鼻 (FET) 手术后下游胸腔血管内主动脉修复 (TEVAR) 的结果。方法 66 名患者在 FET 手术后接受了下游 TEVAR，以治疗胸主动脉夹层 (n = 42, 64%)、动脉瘤 (n = 19, 29%) 或累及主动脉弓的穿透性主动脉溃疡 (n = 5, 8%) ）。分析了患者和结果特征。结果 39 名男性 (59%) 和 27 名女性 (41%) 年龄 68 [四分位距: 56, 75] 岁的患者在 FET 手术后 7 [四分位距: 2-18] 个月进行了下游 TEVAR，其中包括 11 名患者 ( 17%）患有结缔组织病。在 TEVAR 之前，61 名患者 (92%) 接受了脑脊液引流。患者接受了 1 个覆膜支架（n = 28, 42%），2 个覆膜支架（n = 37, 56%）或 3 个覆膜支架（n = 1, 2%）。通过手术切开（n = 15, 23%）或经皮（n = 49, 74%）进入股动脉。一名患者 (2%) 出现了自发消退的暂时性脊髓损伤。没有观察到永久性脊髓损伤、中风或死亡病例。12 [四分位距：2-23] 个月后，15 名患者需要额外的主动脉再介入治疗（血管内：n = 6；手术：n = 9）。结论 FET 手术后的下游 TEVAR 与出色的临床结果相关。因此，我们认为分期胸主动脉修复——FET 和继发性 TEVAR——是一种非常成功和安全的策略。某些患者可能需要三级手术来修复其整个主动脉病变；因此，他们将需要长期持续的随访，