Balloon Fracture Fenestration after Frozen Elephant Trunk Deployment to Eliminate Retrograde False-Lumen Perfusion in a Type B Dissection–Complicated Arch Aneurysm

INTRODUCTION: Arch or proximal descending aortic aneurysms complicated by Stanford type B aortic dissection (TBAD) may require extensive open repair with an open proximal anastomosis. Although a staged modified elephant trunk strategy is a reasonable option, the need to undergo two major operations is burdensome. The frozen elephant trunk (FET) technique enables concomitant treatment of the descending aorta after arch replacement; however, persistent retrograde false-lumen perfusion may result in incomplete aneurysm exclusion and inadequate aortic remodeling. We report a single-stage approach using adjunctive balloon fracture fenestration after FET deployment.