The Elephant Trunk Procedure for Aortic Dissection

(Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan, Department of Surgery II, Tokyo Medical University*, Tokyo, Japan and Department of Thoracic Surgery, Fujita Health University School of Medicine**, Toyoake, Japan)

Nobusato Koizumi* Motomi Ando** Yuji Hanafusa
Osamu Tagusari Hitoshi Ogino Soichiro Kitamura
The elephant trunk procedure is used to close the false lumen of the distal aorta in the surgical treatment for aortic dissection. We examined the state of the false lumen thrombus and measured the diameter of the aortic dissection, using postoperative digital subtraction angiography and computed tomographic scanning. We performed the elephant trunk procedure in 24 cases in the period, between January 1995 to December 1999. Total aortic arch replacement was performed in Stanford type A dissection, and descending aorta replacement was performed in Stanford type B dissection. In all patients, thrombotic closure around the elephant trunk graft was confirmed. Thromboexclusion of the false lumen of the descending aorta was observed in 18 cases (75.0%). The secondary operation may be unnecessary, because there was a tendency towards reduction of the diameter of dissecting aorta. These data revealed that this procedure was effective. In 6 cases (25.0%), residual dissection was recognized in the thoracoabdominal aorta, but there was no case of expansion requiring further operation. Nevertheless, careful follow-up is necessary, because aneurysms could expand in the future.
@Jpn. J. Cardiovasc. Surg. 32: 267 -271 (2003)