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Eur J Cardiothorac Surg 2001;19:528-530
© 2001 Elsevier Science NL

Case report

A dual strategic approach to mega-aortic aneurysms

^a Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
^b Department of Vascular Surgery, Freeman Hospital, Newcastle upon Tyne, UK
^c Department of Radiology, Freeman Hospital, Newcastle upon Tyne, UK

Received 22 November 2000; received in revised form 28 January 2001; accepted 4 February 2001.

Corresponding author. Tel.: +44-705-060-9664; fax: +44-870-126-9994
e-mail: wongch{at}postmaster.co.uk

Staged resection of mega-aortas with Borst's two-stage elephant trunk (ETK) is the gold standard but has a higher mortality and morbidity compared to single-segment repair. We report the first case of combined surgical and covered-stent approach in Europe. Location and dilatation of the proximal landing zone accounts for the majority of failures in covered-stenting but an ETK is stable, easy to localise and gives an excellent seal. In high-risk cases where surgical resection is not offered, stenting is an option. The lack of a thoracotomy is an advantage in often-frail patients recovering from stage-I and shortens ITU-stay. Therefore, a combined approach is an acceptable alternative in selected individuals.

Key Words: Elephant trunk • Mega aortic aneurysm • Thoracic aortic stenting

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