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Eur J Cardiothorac Surg 2005;28:335-336
© 2005 Elsevier Science NL

How-to-do-it

Secondary elephant trunk fixation with endovascular stent grafting for extensive/multiple thoracic aortic aneurysm

Department of Cardiovascular, Thoracic, and Pediatric Surgery, Kobe University, Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan

Received 16 October 2004; received in revised form 5 April 2005; accepted 25 April 2005.

^* Corresponding author. Tel.: +81 78 382 5942; fax: +81 78 382 5959. (Email: yokita{at}med.kobe-u.ac.jp).

Four patients who underwent secondary elephant trunk fixation by endovascular stent grafting are presented and the advantage of this method to treat multiple/extensive thoracic aortic aneurysm is discussed. In two of them, the elephant trunk installation has been performed at another hospital for extensive aortic aneurysm. In two other patients, the aortic arch replacement and the elephant trunk installation were performed through median sternotomy, initially for multiple aortic lesions, including both arch and descending aorta. No neurological deficit, stroke nor spinal cord injury was encountered during the follow-up period (24–40 months). The diameter of the aneurysms decreased markedly in three patients. In one patient, the aneurysm expanded gradually and type II endoleak was treated by coil embolization. In one patient, who showed marked shrinkage of the aneurysm, the stent graft kinked mildly. Based on the low mortality rate of well-established aortic arch surgery, concomitant elephant trunk installation which was followed by the secondary fixation with endovascular stent grafting might be useful to treat multiple/extensive thoracic aneurysm from distal arch to descending aorta.

Key Words: Aneurysm • Thoracic aorta • Aortic arch • Stent graft

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