{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T20:20:35Z","timestamp":1785270035228,"version":"3.55.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T00:00:00Z","timestamp":1710288000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>Intraluminal thrombus formation (ILT) is a recently discovered and highly clinically relevant complication after frozen elephant trunk implantation in cardiovascular surgery. In this phenomenon, a thrombus forms within the lumen of the stent graft component of the frozen elephant trunk prosthesis and puts the patient at risk for downstream embolization with visceral or lower limb ischemia. Incidence of ILT reported in the currently available studies ranges from 6% to 17% of patients after frozen elephant trunk implantation. Adverse thromboembolic events include acute occlusion of the celiac and superior mesenteric arteries, both renal arteries as well as acute lower limb ischemia due to iliac or femoral artery embolization that not infrequently require interventional or open embolectomy. Therefore, the presence of ILT is associated with increased short-term mortality and morbidity. Currently proposed strategies to avoid ILT formation include a more aggressive anticoagulation management, minimization of postoperative coagulation factor application, and even technical optimizations of the stent graft portion itself. If ILT is manifested, the therapeutic strategies tested to date are long-term escalation of anticoagulation and early endovascular extension of the FET stent graft with overstenting of the intraluminal thrombus. The long-term efficiency of these prophylactic and therapeutic measures has yet to be proven. Nonetheless, all surgeons performing the frozen elephant trunk procedure must be aware of the risk of ILT formation to facilitate a timely diagnosis and therapy.<\/jats:p>","DOI":"10.3389\/fcvm.2024.1344292","type":"journal-article","created":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T04:39:23Z","timestamp":1710304763000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Risk factors, prevention, and therapy of intraluminal stent thrombosis in frozen elephant trunk prostheses\u2014what we know so far"],"prefix":"10.3389","volume":"11","author":[{"given":"Florian","family":"Helms","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bastian","family":"Schmack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Weymann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza","family":"Poyanmehr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Martens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jawad","family":"Salman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina","family":"Zubarevich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan D.","family":"Schmitto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjang","family":"Ruhparwar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aron-Frederik","family":"Popov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,3,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1055\/s-2007-1020290","article-title":"Extensive aortic replacement using \u201celephant trunk\u201d prosthesis","volume":"31","author":"Borst","year":"1983","journal-title":"Thorac Cardiovasc Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1016\/j.ejcts.2005.02.046","article-title":"The frozen elephant trunk technique for the treatment of extensive thoracic aortic aneurysms: operative results and follow-up","volume":"28","author":"Karck","year":"2005","journal-title":"Eur J Cardiothorac Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1550","DOI":"10.1016\/S0022-5223(03)00045-X","article-title":"The frozen elephant trunk technique: a new treatment for thoracic aortic aneurysms","volume":"125","author":"Karck","year":"2003","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1093\/ejcts\/ezv085","article-title":"Current status and recommendations for use of the frozen elephant trunk technique: a position paper by the vascular domain of EACTS","volume":"47","author":"Shrestha","year":"2015","journal-title":"Eur J Cardiothorac Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1093\/ejcts\/ezy313","article-title":"Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS)","volume":"55","author":"Czerny","year":"2019","journal-title":"Eur J Cardiothorac Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"427","DOI":"10.21470\/1678-9741-2019-0220","article-title":"Which is the optimal frozen elephant trunk? A systematic review and meta-analysis of outcomes in 2161 patients undergoing thoracic aortic aneurysm surgery using E-vita OPEN PLUS hybrid stent graft versus thoraflex\u2122 hybrid prosthesis","volume":"35","author":"Harky","year":"2020","journal-title":"Braz J Cardiovasc Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1093\/ejcts\/ezu067","article-title":"The frozen elephant trunk technique for the treatment of complicated type B aortic dissection with involvement of the aortic arch: multicentre early experience","volume":"47","author":"Weiss","year":"2015","journal-title":"Eur J Cardiothorac Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1093\/icvts\/ivu323","article-title":"Is extended arch replacement justified for acute type A aortic dissection?","volume":"20","author":"Li","year":"2015","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"S116","DOI":"10.1016\/j.jtcvs.2010.07.066","article-title":"Multicenter early experience with extended aortic repair in acute aortic dissection: is simultaneous descending stent grafting justified?","volume":"140","author":"Tsagakis","year":"2010","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1093\/ejcts\/ezu173","article-title":"The frozen elephant trunk technique for acute type A aortic dissection: results from 15 years of experience\u2020","volume":"47","author":"Katayama","year":"2015","journal-title":"Eur J Cardiothorac Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"642","DOI":"10.3978\/j.issn.2225-319X.2013.09.03","article-title":"Sun\u2019s procedure for complex aortic arch repair: total arch replacement using a tetrafurcate graft with stented elephant trunk implantation","volume":"2","author":"Ma","year":"2013","journal-title":"Ann Cardiothorac Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1016\/j.athoracsur.2008.11.061","article-title":"Operative strategy for acute type a aortic dissection: ascending aortic or hemiarch versus total arch replacement with frozen elephant trunk","volume":"87","author":"Uchida","year":"2009","journal-title":"Ann Thorac Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1093\/ejcts\/ezu096","article-title":"Thoracoabdominal aortic aneurysm repair after frozen elephant trunk procedure","volume":"47","author":"Folkmann","year":"2015","journal-title":"Eur J Cardiothorac Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1177\/152660280100800406","article-title":"Thrombus formation in aortic endografts","volume":"8","author":"Wegener","year":"2001","journal-title":"J Endovasc Ther"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1558","DOI":"10.1016\/j.jvir.2008.08.007","article-title":"Mural thrombotic deposits in abdominal aortic endografts are common and do not require additional treatment at short-term and midterm follow-up","volume":"19","author":"Maleux","year":"2008","journal-title":"J Vasc Interv Radiol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"729","DOI":"10.23736\/S0021-9509.20.11267-9","article-title":"Prevalence, risk factors and clinical impact of intraprosthetic thrombus deposits after EVAR","volume":"61","author":"Bianchini Massoni","year":"2020","journal-title":"J Cardiovasc Surg (Torino)"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ejvsvf.2022.03.003","article-title":"Escalation of antithrombotic therapy should be considered in the presence of intraluminal prosthetic graft thrombus following endovascular aneurysm repair","volume":"56","author":"Russell","year":"2022","journal-title":"EJVES Vasc Forum"},{"key":"B18","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.ejvsvf.2022.02.006","article-title":"Intragraft thrombosis after TEVAR for BTAIs: mounting evidence and open questions","volume":"55","author":"Buongiovanni","year":"2022","journal-title":"EJVES Vasc Forum"},{"key":"B19","doi-asserted-by":"publisher","first-page":"5583120","DOI":"10.1155\/2022\/5583120","article-title":"Late stent thrombosis in a patient with endovascular aortic repair for blunt thoracic aortic injury","volume":"2022","author":"Chiu","year":"2022","journal-title":"Case Rep Vasc Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European Society of Cardiology (ESC)","volume":"35","author":"Erbel","year":"2014","journal-title":"Eur Heart J"},{"key":"B21","doi-asserted-by":"publisher","first-page":"921479","DOI":"10.3389\/fcvm.2022.921479","article-title":"Postoperative in-stent thrombus formation following frozen elephant trunk total arch repair","volume":"9","author":"Walter","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"S0022-X","DOI":"10.1016\/j.jtcvs.2023.01.014","article-title":"Features and risk factors of early intraluminal thrombus formation within the frozen elephant trunk stent graft","author":"Martens","year":"2023","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B23","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1016\/j.athoracsur.2022.12.030","article-title":"Early intraluminal frozen elephant trunk stent graft thrombosis after aortic arch surgery","volume":"116","author":"Misfeld","year":"2023","journal-title":"Ann Thorac Surg"},{"key":"B24","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/1476-7120-2-21","article-title":"Atherosclerosis of the descending aorta predicts cardiovascular events: a transesophageal echocardiography study","volume":"2","author":"Varga","year":"2004","journal-title":"Cardiovasc Ultrasound"},{"key":"B25","doi-asserted-by":"publisher","first-page":"S44","DOI":"10.4103\/0971-9784.192623","article-title":"Transesophageal echocardiography evaluation of the thoracic aorta","volume":"19","author":"Patil","year":"2016","journal-title":"Ann Card Anaesth"},{"key":"B26","doi-asserted-by":"publisher","first-page":"606","DOI":"10.3978\/j.issn.2225-319X.2013.09.22","article-title":"Early- and medium-term results after aortic arch replacement with frozen elephant trunk techniques\u2014a single center study","volume":"2","author":"Leontyev","year":"2013","journal-title":"Ann Cardiothorac Surg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1286","DOI":"10.1016\/j.jtcvs.2015.01.044","article-title":"The elephant trunk is freezing: the hannover experience","volume":"149","author":"Shrestha","year":"2015","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B28","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1016\/j.jvs.2011.07.075","article-title":"Surgical conversion for intragraft thrombosis following endovascular repair of traumatic aortic injury","volume":"55","author":"Marone","year":"2012","journal-title":"J Vasc Surg"},{"key":"B29","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.avsg.2009.05.013","article-title":"Endovascular treatment of traumatic thoracic aortic injuries: short- and medium-term follow-up","volume":"24","author":"Fernandez","year":"2010","journal-title":"Ann Vasc Surg"},{"key":"B30","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.jvs.2021.07.226","article-title":"Female gender is associated with increased late luminal narrowing within the stent graft after thoracic endovascular aortic repair","volume":"75","author":"Kuo","year":"2022","journal-title":"J Vasc Surg"},{"key":"B31","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1007\/s13239-021-00521-2","article-title":"PIV analysis of haemodynamics distal to the frozen elephant trunk stent surrogate","volume":"12","author":"Williamson","year":"2021","journal-title":"Cardiovasc Eng Technol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1017\/S1047951109991880","article-title":"Successful treatment of a thrombus in the left aortic coronary sinus in a child with systemic lupus erythematosus","volume":"20","author":"Georgiev","year":"2010","journal-title":"Cardiol Young"},{"key":"B33","doi-asserted-by":"publisher","first-page":"168","DOI":"10.3121\/cmr.2009.866","article-title":"Virchow\u2019s contribution to the understanding of thrombosis and cellular biology","volume":"8","author":"Kumar","year":"2010","journal-title":"Clin Med Res"},{"key":"B34","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1016\/0741-5214(86)90039-X","article-title":"Dacron inhibition of arterial regenerative activities","volume":"3","author":"Greisler","year":"1986","journal-title":"J Vasc Surg"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2024.1344292\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T04:39:30Z","timestamp":1710304770000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2024.1344292\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,13]]},"references-count":34,"alternative-id":["10.3389\/fcvm.2024.1344292"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2024.1344292","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,13]]},"article-number":"1344292"}}