Extension of the “Elephant Trunk” Technique in Complex Aortic Pathology: The “Bidirectional” Option 1 Thierry Carrel, MD, Ulrich Althaus, MD The Annals.

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Presentation transcript:

Extension of the “Elephant Trunk” Technique in Complex Aortic Pathology: The “Bidirectional” Option 1 Thierry Carrel, MD, Ulrich Althaus, MD The Annals of Thoracic Surgery Volume 63, Issue 6, Pages 1755-1758 (June 1997) DOI: 10.1016/S0003-4975(97)00332-9

Fig. 1 Schematic representation of the bidirectional elephant trunk graft after positioning in the proximal segment of the descending aorta, before unfolding the distal part in the downstream aorta. The proximal trunk remains invaginated in the cranial part of the graft and can be pulled out from a sternotomy approach when aortic arch replacement is required. The Annals of Thoracic Surgery 1997 63, 1755-1758DOI: (10.1016/S0003-4975(97)00332-9)

Fig. 2 Magnetic resonance imaging in a patient with operated type A dissection and symptomatic dilation of the descending aorta. Note the incidental finding of more proximal pathology at the origin of the innominate artery. The Annals of Thoracic Surgery 1997 63, 1755-1758DOI: (10.1016/S0003-4975(97)00332-9)

Fig. 3 Computed tomogram demonstrating contained rupture of the proximal descending aorta. There are severe atherosclerotic alterations of the aortic arch, but the caliber of the latter seems rather normal. No dissection was visualized by computed tomographic scan. The Annals of Thoracic Surgery 1997 63, 1755-1758DOI: (10.1016/S0003-4975(97)00332-9)

Fig. 4 Transesophageal echocardiography allowed us to demonstrate the presence of a dissecting membrane in the transverse aortic arch. In the absence of a typical entry in the ascending aorta, a type B aortic dissection with retrograde extension in the aortic arch was suspected. The Annals of Thoracic Surgery 1997 63, 1755-1758DOI: (10.1016/S0003-4975(97)00332-9)

Fig. 5 (A) Intraoperative view of the proximal elephant trunk still invaginated in the proximal segment of the descending aorta; the aortic arch has been completely resected and the supraaortic vessels excised with a generous patch of aortic wall. (B) Same view after unfolding the elephant trunk with the aid of a nerve hook; only minor clots were observed on the external layer of the prosthesis. The Annals of Thoracic Surgery 1997 63, 1755-1758DOI: (10.1016/S0003-4975(97)00332-9)