Abstract

A CASE STUDY ON NOVEL AND CLASSIC ELEPHANT TRUNK PROCEDURES

Mohammed Muneeruddin*, Venu Talla, Divya Amara, Tejaswi Uppala and Poojitha Mutte

ABSTRACT

The elephant trunk procedure, in which a graft is inserted into a true lumen of distal aorta, is useful for closing the false lumen of the descending aorta. The open surgical treatment of an aortic disease (aneurysm or dissection) that affects the full length of the thoracic aorta is challenging surgically. However, H.G. Borst and colleagues found that with the classic technique (conventional arch replacement followed by descending aortic replacement), mobilization of the previous graft at the distal arch anastomosis was difficult and which might result in injury to the pulmonary artery, the aorta itself, the esophagus, and other nearby structures. As a consequence, they invented the Elephant Trunk approach in 1992, which Crawford and Svensson later refined. The classic Elephant Trunk procedure, which has two stages, fits within this aggressive paradigm and allows for the rectification of coexisting or subsequent descending aortic dilatation. In 2003, the classic two-stage technique’s novelty was advanced to one stage frozen elephant trunk technique which is a combination of stent and graft which will be inserted into the descending aorta followed by suturing into neck and other arteries that supply blood to heart and this procedure is associated with deep hypothermic circulatory arrest. Our study gives an overall description of 2 patients who underwent one-stage frozen elephant trunk procedure and two-stage classic elephant trunk procedure respectively.

Keywords: Aorta, Aneurysm, Dissection, Lumen, Frozen.