Use of the “elephant trunk technique” in aortic surgery

Background. In aortic replacement, the “elephant trunk technique” uses surplus intravascular graft length to facilitate subsequent operations on the downstream aorta. This study investigates the experience with the technique since its conception by our group. Methods. Between 1982 and 1994, 80 elephant trunks were implanted in 72 patients. In 40 cases the primary position was in the proximal descending thoracic aorta, extending an aortic arch graft. In 32 instances the elephant trunk was placed in the distal descending thoracic aorta, extending descending aortic replacement. Aortic pathology comprised aneurysms in 22 cases, chronic dissection in 47, and acute dissection in 3. Fourteen patients had Marfanʹs syndrome. Results. There was a total of 10 early deaths, 7 of which occurred during the early experience. Subsequent downstream aortic operation was undertaken in 24 patients after a mean interval of 14 months, replacing the descending thoracic aorta in 17 cases and the thoracoabdominal portion in 7 cases. Six patients underwent third-stage procedures. Several technical modifications were developed, helping to ease placement and unfolding of the trunk. Conclusions. The elephant trunk technique greatly facilitates and at the same time reduces the risk of multiple-stage aortic replacement.