It's Topic Tuesday

Good morning everyone! Welcome back and today we will be discussing the Elephant Trunk procedure, what it is, the indications, and considerations.

The Elephant Trunk is a procedure where tubular graft material is inserted during ascending aortic and arch repair to facilitate future treatment of distal aortic aneurysms. This surgical approach has improved the results and outcomes of complex replacement of the ascending aorta, aortic arch, and distal aorta, and has resulted in better survival than those of traditional approaches.

Indications

The elephant trunk approach is used when extensive thoracic aortic disease requires a two-stage repair: repair of the ascending aorta and aortic arch (Stage I) followed by repair of the descending aorta with or without repair of the abdominal aorta (Stage II). The procedure is indicated for aortic aneurysms due to atherosclerosis, post dissection, inflammation, and less frequently even for dissections.

Stage I:

Briefly, the surgeon sutures a folded end of the tubular graft to the aortic arch, distal to the great vessels. The proximal portion of the graft is then retracted into the aortic arch and sutured proximally. The distal portion of the graft, the free end, remains draped in the descending thoracic aorta for the second-stage surgery to repair the descending thoracic aorta.

Johnson et al. “The Elephant Trunk Procedure for Aortic Aneurysm Repair: An Illustrated Guide to Surgical Technique With CT Correlation” AJR 2012

Stage II:

In planning for stage II, adequate recovery time is balanced with the risk of descending thoracic aortic rupture. In this stage, the descending aorta is replaced with a graft that incorporates the elephant trunk.

Johnson et al. “The Elephant Trunk Procedure for Aortic Aneurysm Repair: An Illustrated Guide to Surgical Technique With CT Correlation” AJR 2012

Complications

Similar to other complex aortic surgeries, the elephant trunk procedure is associated with a risk of graft occlusion, graft kinking, neurologic dysfunction including stroke, encephalopathy, spinal cord injury, mediastinitis, kidney dysfunction, the need for tracheostomy, bleeding, and death.

This is all for what we have today! We hope you have found this brief overview about the Elephant Trunk procedure to be educational.

Thank you for tuning in and please join us back here next week. Have a wonderful week ahead and stay healthy!

Duc Giao