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

Abstract

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.

Hybrid treatment for aortic arch and proximal descending thoracic aneurysm: experience with stent grafting for second-stage elephant trunk repair☆

“…Along with the advent of transfemoral stent grafts for the treatment of descending aortic aneurysms, it has been possible to securely anchor a stent graft in an elephant trunk prosthesis previously placed during arch surgery [2]. The list of published series of endovascular completion after previous elephant trunk procedure is summarised in Table 4 [3][4][5][6][7][8][9][10]. Although this cohort is relatively small, the procedural results seem promising with a low risk for paraplegia.…”

“…To evade the invasive procedure of left thoracotomy for descending thoracic aortic aneurysms in second-stage operation, we advocate the less-invasive endovascular stent grafting in fixing the elephant trunk. Therefore, the elephant trunk could be the most suitable condition as proximal neck of the stent graft; and endovascular repairs have been selectively employed in place of the next operation [3][4][5][6][7][8][9][10].…”

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

“…Starting in 1995, a TEVAR approach was introduced for second-stage completion of the aortic repair. [15][16][17] Other techniques that have been developed include the hybrid surgical/endovascular approach, the so-called frozen elephant trunk, 18,19 and the aortic arch debranching and stenting techniques. 20,21 In this study, we report on the outcomes of the 2-stage ET technique, updating the previous report from 2002.…”

Progress of the treatment for extended aortic aneurysms; is the frozen elephant trunk technique the next standard in the treatment of complex aortic disease including the arch?☆

“…Along with the advent of transfemoral stentgrafts for the treatment of descending aortic aneurysms it became possible to securely anchor a stent-graft in an elephant trunk prosthesis previously placed during arch surgery [9]. Published series of endovascular completion after previous elephant trunk procedure are summarized in Table 2 [27][28][29][30]. Although this cohort is relatively small, the procedural results seem to be promising with a low risk for paraplegia.…”