General Thoracic and Cardiovascular Surgery

, Volume 66, Issue 8, pp 492–494 | Cite as

Devising a technique for distal anastomosis during total arch replacement using the frozen elephant trunk technique: reverse stepwise anastomosis

  • Hidenori Sako
  • Hideyuki Tanaka
  • Masato Morita
  • Tetsushi Takayama
How to Do It


Frozen elephant technique is an effective procedure used to repair complex thoracic aortic disease involving the aortic arch and the descending aorta, or to treat aortic dissection. However, the technique often requires some creativity to properly place the stent graft and anastomose the graft to the aorta. We recently used the J Graft FROZENIX® (Japan Lifeline Co., Ltd., Tokyo, Japan) in total arch replacement, and devise a technique for distal anastomosis (called “reverse stepwise anastomosis”) that was simple and easy and caused minimal bleeding.


Aortic surgery Stent graft Aortic arch Aortic dissection Aneurysm 



No funding was received for the publication of this paper.

Compliance with ethical standards

Conflict of interest

The authors have declared that no conflicts of interest exist.


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Copyright information

© The Japanese Association for Thoracic Surgery 2018

Authors and Affiliations

  1. 1.Department of Cardiovascular SurgeryOita Oka HospitalOitaJapan

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