1. Illustration of the reversed elephant trunk technique using a traditional “island” approach to total aortic arch replacement. A. Stage 1: The distal aorta is repaired through a left thoracoabdominal approach. The aneurysm is opened after the aorta is clamped between the left common carotid artery and the left subclavian artery, which is also clamped. Before the proximal anastomosis is performed, the end of the graft is partly invaginated to leave a “trunk” for the subsequent repair. Proximal intercostal arteries are oversewn. B. After the proximal suture line is completed, the clamps are repositioned to restore blood flow to the left subclavian artery. The repair is completed by reattaching patent intercostal arteries to an opening in the side of the graft and creating a beveled distal anastomosis at the level of the visceral branches. C. Stage 2: The proximal aorta is repaired through a median sternotomy. The aortic arch is opened under hypothermic circulatory arrest. The “trunk” is pulled out and used to replace the aortic arch and ascending aorta. This eliminates the need for a new distal anastomosis and simplifies the procedure. Circulatory arrest and operative time, along with their attendant risks, are reduced. D. The completed two-stage repair of the entire thoracic aorta. (Reproduced with permission from Coselli JS, LeMaire SA, Carter SA, et al: The reversed elephant trunk technique used for treatment of complex aneurysms of the entire thoracic aorta. Ann Thorac Surg 2005; 80:2166, Figs. 2, 3, 7,8. Copyright The Society of Thoracic Surgeons.)
Source: Thoracic Aneurysms and Aortic Dissection, Schwartz's Principles of Surgery, 10e
Citation: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. Schwartz's Principles of Surgery, 10e; 2014 Available at: Accessed: October 27, 2017
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