Use of the “elephant trunk technique” in aortic surgery

Heinemann, Markus K.; Buehner, Beate; Jurmann, M.; Borst, H. G.

doi:10.1016/s0003-4975(95)00319-3

Cited by 102 publications

(56 citation statements)

References 7 publications

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“…The results in the current series and the favorable outcome demonstrated in previous studies of distal aortic perfusion and cerebrospinal fluid drainage ensure the continued use of these adjuncts in elephant trunk procedures. 14 There have been some variations in Dr Borst's original design of the elephant trunk technique, [15][16][17][18][19] but the objective-to reduce surgical risks in extensive aortic aneurysm repair-remains the same.…”

Section: Discussionmentioning

confidence: 99%

Staged Repair of Extensive Aortic Aneurysms

et al. 2001

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Background-Extensive aortic aneurysms (ascending aorta, aortic arch, and descending or thoracoabdominal aorta) require innovative surgical techniques. Some surgeons advocate a single procedure with long periods of profound hypothermia, whereas others use a staged approach. We adopted a two-staged procedure (elephant trunk technique) in 1991 for elective repair of extensive aortic aneurysms. Methods and Results-Between February 1991 and May 2000, we performed a total of 1146 aortic aneurysm operations.Of these, 182 (15.9%) operations were first-or second-stage elephant trunk procedures, performed in a total of 117 patients. Stage 1 was completed in all 117 patients. Stage 2 was completed in 65 (55.6%) of 117 patients. Thirty-day mortality rate for the first stage was 5.1% (6 of 117). Mortality rate during the interval between operations was 3.6% (4 of 111), of which 75% (3of 4) were the result of aneurysm rupture. Thirty-day mortality rate for the second stage was 6.2% (4 of 65). A total of 43 patients did not return for second-stage repair. Among these patients, within an average period of 3.4 years (range, 1.5 months to 4.9 years), 13 of 43 (30.2%) died, 4 of 13 (30.8%) as the result of rupture. Two of 117 (1.7%) first-stage patients had postoperative stroke. No spinal cord dysfunction occurred in second-stage patients. Conclusions-Extensive aortic aneurysms can be repaired with acceptable morbidity and mortality rates through the use of the elephant trunk technique. Death was most commonly the result of rupture, both in interval patients awaiting scheduled second-stage repair and in patients who did not return. After the first stage, prompt treatment of the remaining segment is crucial to the success of staged repair.

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Section: Discussionmentioning

confidence: 99%

Staged Repair of Extensive Aortic Aneurysms

et al. 2001

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“…Several reports have described cases in which this complication required that distal attachment be performed under emergency conditions immediately after the first stage. 2,3,5,6 Another risk of the elephant trunk technique is rupture during the interval between the first and second stage due to increased pressure in the false lumen after resection of the intimal layer in the first stage. This complication was not observed in our series but has been reported by others.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Aortic Arch Dissection Using the Elephant Trunk Technique

Kieffer

Koskas

Godet

et al. 2000

Annals of Vascular Surgery

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“…In such patients, the traditional surgical treatment is a 2-staged procedure named the "elephant trunk technique." 102 In the first stage, the ascending aorta and aortic arch are repaired via a median sternotomy, and an extra-long graft is used for reconstruction, which leaves the excess portion of the graft, the elephant trunk, dangling within the lumen of the remaining diseased aorta. In the second stage, the lesion in the descending aorta is repaired via a left thoracotomy, and the graft replacement is connected to the elephant trunk proximally.…”

Section: Future Directionsmentioning

confidence: 99%