Merits and Demerits of the Reversed Elephant Trunk Technique Based on Experiences with 6 Cases

(Department of Cardiovascular Surgery, Japan Red Cross Society Wakayama Medical Center, Wakayama Japan)

Naoki Kanemitsu Masaki Aota Shingo Hirao
We encountered 6 cases of descending or thoracoabdominal aortic aneurysm operation with reversed elephant trunk(R-ET). R-ET was originally developed by Dr. Carrel in order to circumvent the dissection of the proximal anastomotic site from surrounding organs such as the lung, recurrent nerve, phrenic nerve, and esophagus in the future proximal aortic replacement. Three of 6 patients underwent a 2nd operation(total arch replacement). Distal anastomosis was easy and safe. One patient had multiple cerebral infarction and died after the second operation, but no patient suffered from complications derived from injury to the lung, esophagus, recurrent nerve or phrenic nerve. During outpatient follow-up, 1 patient who had suffered from paraparesis after the 1st operation died of repture of an arch aneurysm before the 2nd operation could be. Thrombosis was found between the inside and outside grafts of R-ET in 2 patients, who had been implanted with Gelweave prosthesis. There were no negative events caused by the thrombus. One patient with the thrombus underwent total arch replacement. We removed the fibrin-like thrombus from the R-ET prosthesis under endoscopic visualization without any complication. R-ET is a very easy and useful technique, but one should exert care about the thrombus formation around the R-ET.
  Jpn. J. Cardiovasc. Surg. 41:53-57(2012)

Keywords:reversed elephant trunk technique, multiple thoracic aortic aneurysms