{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T04:34:44Z","timestamp":1760243684377,"version":"build-2065373602"},"reference-count":21,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T00:00:00Z","timestamp":1665964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>(1) Aim: The primary endpoint of this study was to evaluate the impact of frozen elephant trunk (FET) and conventional elephant trunk (CET) on aortic mural thrombus. The secondary endpoint was to investigate the incidence of persistent inflammatory response (IR) in the form of post-implantation syndrome (PIS) or persistent fever without infection focus after FET and CET, respectively, as well as the risk factors associated with its occurrence. (2) Methods: A single-center, retrospective, observational study of 57 consecutive patients treated with FET and CET between April 2015 and June 2020 was performed. Demographics, procedural data, perioperative laboratory exams as well as vital parameters were recorded. Pre- and postoperative computer tomography angiography (CTA) scans were analyzed with a dedicated software. IR was defined as the presence of continuous fever (&gt;38\u00b0, lasting &gt; 24 h) and leukocytosis (white blood cell count &gt; 12 \u00d7 1000\/\u00b5L) developing after surgery in the absence of an infection focus. (3) Results: Fifty-seven consecutive patients (mean age 58.4 \u00b1 12.6 years, 36.8% females) treated with FET (66.6%) or CET (33.3%) for acute aortic dissection (56.1%), post-dissection-aneurysm (19.2%) or aortic aneurysm (24.5%) were included. The median thrombus volume on CTA preoperatively was 10.1 cm3 (range 2\u2013408 cm3). After surgery, the median new-onset mural thrombus was 9.7 cm3 (range 0.2\u2013376 cm3). Nineteen (33.3%) patients developed IR; patients with IR were significantly younger (p = 0.027), less frequently of female gender (p = 0.003) and more frequently affected from acute dissection (p = 0.002) and stayed in the intensive care unit (ICU) significantly longer (p = 0.033) than those without IR. Postoperatively, the volume of new-onset thrombus was significantly greater in the IR group (84.4 vs. 3.2 cm3, p &lt; 0.001). (4) Conclusions: In the context of CET and FET, the persistent inflammatory response occurred in 33.3% of the patients with persistent fever without infection focus. IR was associated with a higher volume of new-onset thrombus and significantly prolonged ICU stay. Further studies to investigate these observations are needed.<\/jats:p>","DOI":"10.3390\/diagnostics12102511","type":"journal-article","created":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T02:29:46Z","timestamp":1665973786000},"page":"2511","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Frozen and Conventional Elephant Trunk on Aortic New-Onset Thrombus and Inflammatory Response"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2643-2621","authenticated-orcid":false,"given":"Elena","family":"Marchiori","sequence":"first","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, University Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6322-7152","authenticated-orcid":false,"given":"Alexander","family":"Oberhuber","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, University Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sven","family":"Martens","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0869-1630","authenticated-orcid":false,"given":"Andreas","family":"Rukosujew","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdulhakim","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, University Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"803","DOI":"10.2459\/JCM.0b013e328364559c","article-title":"Conventional versus Frozen Elephant Trunk Surgery for Extensive Disease of the Thoracic Aorta","volume":"15","author":"Borger","year":"2014","journal-title":"J. Cardiovasc. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"6192","DOI":"10.21037\/jtd.2018.10.42","article-title":"Total Aortic Arch Replacement Using Elephant Trunk or Frozen Elephant Trunk Technique: A Case-Control Matching Study","volume":"10","author":"Mkalaluh","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","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":"ref_4","doi-asserted-by":"crossref","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":"ref_5","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/S0002-9610(99)00144-0","article-title":"Perigraft Air, Fever, and Leukocytosis after Endovascular Repair of Abdominal Aortic Aneurysms","volume":"178","author":"Carpenter","year":"1999","journal-title":"Am. J. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"4311","DOI":"10.21037\/jtd-21-398","article-title":"Post-Implantation Syndrome after Frozen Elephant Trunk Is Associated with the Volume of New-Onset Aortic Thrombus","volume":"13","author":"Ibrahim","year":"2021","journal-title":"J. Thorac. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s13019-018-0712-y","article-title":"Volume of Mural Thrombus Plays a Role in the Elevation of Inflammatory Markers after Endovascular Aortic Repair","volume":"13","author":"Lee","year":"2018","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"398","DOI":"10.23736\/S0392-9590.20.04163-2","article-title":"Post-Implantation Syndrome: The Impact of Different Devices for Endovascular Abdominal Aortic Aneurysm Repair and Related Etiopathogenetic Implications","volume":"39","author":"Martinelli","year":"2020","journal-title":"Int. Angiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1024\/0301-1526\/a000913","article-title":"Postimplantation Syndrome in Endovascular Aortic Aneurysm Repair\u2014A Systematic Review","volume":"50","author":"Bradley","year":"2021","journal-title":"Vasa"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1510\/icvts.2010.256784","article-title":"Post-Implantation Syndrome Following Endovascular Abdominal Aortic Aneurysm Repair: Preliminary Data","volume":"12","author":"Arnaoutoglou","year":"2011","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1093\/ejcts\/ezv355","article-title":"Clinical Features and Prognostic Value of Stent-Graft-Induced Post-Implantation Syndrome after Thoracic Endovascular Aortic Repair in Patients with Type B Acute Aortic Syndromes","volume":"49","author":"Gorla","year":"2016","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1007\/s00380-014-0612-6","article-title":"Results of \u201cElephant Trunk\u201d Total Aortic Arch Replacement Using a Multi-Branched, Collared Graft Prosthesis","volume":"31","author":"Schneider","year":"2016","journal-title":"Heart Vessels"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"924838","DOI":"10.3389\/fcvm.2022.924838","article-title":"Single-Center Experience With the ThoraflexTM Hybrid Prosthesis: Indications, Implantation Technique and Results","volume":"9","author":"Wisniewski","year":"2022","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"60","DOI":"10.21037\/jtd-20-2356","article-title":"Quantification of Volume Changes in the Descending Aorta after Frozen Elephant Trunk Procedure Using the Thoraflex Hybrid Prosthesis for Type A Aortic Dissection","volume":"13","author":"Usai","year":"2021","journal-title":"J. Thorac. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1093\/ejcts\/ezy379","article-title":"Predictors Associated with an Increased Prevalence of Postimplantation Syndrome after Thoracic Endovascular Aortic Repair for Type B Aortic Dissection\u2020","volume":"55","author":"Zhu","year":"2019","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1093\/ejcts\/ezz104","article-title":"Comparative Study of the Frozen Elephant Trunk and Classical Elephant Trunk Techniques to Supplement Total Arch Replacement for Acute Type A Aortic Dissection","volume":"56","author":"Inoue","year":"2019","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1038\/aps.2017.212","article-title":"Cytokines as Biomarkers of Inflammatory Response after Open versus Endovascular Repair of Abdominal Aortic Aneurysms: A Systematic Review","volume":"39","author":"Tsilimigras","year":"2018","journal-title":"Acta Pharmacol. Sin."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.avsg.2019.04.025","article-title":"Aortic Banding to Treat Simultaneously a Type Ia Endoleak and Aortic Neck Rupture during Endovascular Abdominal Aortic Aneurysm Repair","volume":"61","author":"Moulakakis","year":"2019","journal-title":"Ann. Vasc. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1016\/S0741-5214(98)70092-8","article-title":"Adverse Reactions during Endovascular Treatment of Aortic Aneurysms May Be Triggered by Interleukin 6 Release from the Thrombotic Content","volume":"28","author":"Swartbol","year":"1998","journal-title":"J. Vasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1016\/j.jvs.2012.06.072","article-title":"Stent Graft Composition Plays a Material Role in the Postimplantation Syndrome","volume":"56","author":"Hoeks","year":"2012","journal-title":"J. Vasc. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e4532","DOI":"10.1097\/MD.0000000000004532","article-title":"Effects of Postimplantation Systemic Inflammatory Response on Long-Term Clinical Outcomes after Endovascular Aneurysm Repair of an Abdominal Aortic Aneurysm","volume":"95","author":"Kwon","year":"2016","journal-title":"Medicine"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/10\/2511\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:55:23Z","timestamp":1760144123000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/10\/2511"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,17]]},"references-count":21,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["diagnostics12102511"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics12102511","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2022,10,17]]}}}