Modifications, Classification, and Outcomes of Elephant-Trunk Procedures

Inflammatory disease of the aorta: Patterns and classification of giant cell aortitis, Takayasu arteritis, and nonsyndromic aortitis

“…22 The results achieved in this series are similar to other ascending and arch reports, although in the giant cell and isolated aortitis groups we more frequently used prophylactic elephant trunk procedures, anticipating that later second-stage procedures would be required. [23][24][25][26][27][28][29][30] The need for a second procedure can be somewhat guided by the classification of the extent of disease ( Figure 2). We believe that, on the basis of this and earlier reports, the histologic extent of aortic involvement falls into 4 classification groups and that greater vessel arch artery or visceral branch artery influences requirements for additional procedures.…”

The classic elephant trunk technique for staged thoracic and thoracoabdominal aortic repair: Long-term results

“…The resulting double-layered graft was inserted into the descending aorta, just distally from the origin of the left subclavian artery (according to Svensson and colleagues' type I classification). 9 The distal anastomosis was completed by suturing the end of the double-layered graft to the proximal descending aorta and subsequently unfolding the prosthesis by pulling the stay suture. Next, an elliptical opening was made to reimplant the cerebral vessels using an island technique.…”

Staged repair of thoracoabdominal aneurysm with infra-renal elephant trunk graft

“…Advancements in endovascular stent devices have now permitted minimally invasive second stage repairs. The “frozen elephant‐trunk” modification now includes arch repair with a covered thoracic aortic stent placed into the descending aorta . After convalescence, a second‐stage TEVAR completes the repair and avoids thoracotomy …”

“…The "frozen elephant-trunk" modification now includes arch repair with a covered thoracic aortic stent placed into the descending aorta. 4 After convalescence, a second-stage TEVAR completes the repair and avoids thoracotomy. 1 Evolving strategies for repair of TAA have been described including hybrid debranching with endovascular exclusion, and fenestrated total endovascular repair in select high-risk patients.…”