We describe a case of frozen elephant trunk deployment unintentionally
malpositioned into the false lumen. An 83-year-old man underwent total
arch repair with a frozen elephant trunk for type A acute aortic
dissection complicated by mesenteric malperfusion. However,
intraoperative transesophageal echocardiography showed expansion of the
false lumen in the descending aorta, suggesting a malpositioned frozen
elephant trunk into the false lumen. Endovascular fenestration of the
dissecting flap and subsequent endograft deployment from the inside of
the malpositioned frozen elephant trunk graft to the true lumen of the
descending aorta was successfully performed under intravascular
ultrasound guidance.