Comprehensive treatment of pathology of the ascending, arch and descending thoracic aorta by performing operations of the hybrid "elephant trunk"

The purpose of the study – study and demonstration of the possibilities of the technique of complete replacement of the ascending, arch, vessels of the arch and descending thoracic aorta "elephant trunk" surgery in patients with aortic arch aneurysms.Material and methods. The paper describes the technique and demonstrates the results of the first 29 operations of prosthetics of the ascending, arch, vessels of the arch and descending thoracic aorta, which were performed by the staff of the Department of Surgical Treatment of Aortic Pathology National M.Amosov ICVS of the NAMS of Ukraine" in 2016-2020. Results. Hospital mortality was 10.3%, three patients died. The causes of death were: the following acute cardiovascular failure, uncontrolled bleeding, and multiple organ failure in each case. In none of the operated patients the level of postoperative blood loss did not require rethoracotomies.Conclusions. The optimal way to correct aneurysms of the aortic arch is the operation of prosthetics of the ascending, arch and descending thoracic aorta - "elephant trunk". Improvement of preoperative diagnostics, surgical equipment, optimization of methods of protection of the brain, spinal cord and visceral organs, the possibility of using hybrid / endovascular techniques to treat patients with complex lesions of the aortic arch pool with hospital mortality within 10.3%.

Download Full-text

A Case Report of Delayed-Onset Lower Spinal Cord Injury after Replacement of the Aortic Arch and the Descending Thoracic Aorta Using a Stented Elephant Trunk

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.33.189 ◽

2004 ◽

Vol 33 (3) ◽

pp. 189-192

Author(s):

Takashi Kunihara ◽

Kenji Matsuzaki ◽

Norihiko Shiiya ◽

Keishu Yasuda

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Case Report ◽

Aortic Arch ◽

Thoracic Aorta ◽

Descending Thoracic Aorta ◽

Elephant Trunk ◽

Delayed Onset ◽

Cord Injury

Download Full-text

PP-355 Endovascular Stenting Extension of Elephant Trunk Surgical Graft to Lower Descending Thoracic Aorta in a Patient with Aortic Arch and Descending Aortic Aneurysm

The American Journal of Cardiology ◽

10.1016/j.amjcard.2014.01.385 ◽

2014 ◽

Vol 113 (7) ◽

pp. S150-S151

Author(s):

V.V. Vijan ◽

N. Mathew

Keyword(s):

Aortic Aneurysm ◽

Aortic Arch ◽

Thoracic Aorta ◽

Descending Thoracic Aorta ◽

Endovascular Stenting ◽

Elephant Trunk ◽

Descending Aortic Aneurysm

Download Full-text

Acute Type A Aortic Dissection—Replacement of Ascending Aorta, Aortic Arch and Antegrade Stenting of the Descending Thoracic Aorta Using the Thoraflex™ Hybrid Plexus Device (Terumo Aortic)—“Frozen Elephant Trunk”: The Plymouth Way!

Open Journal of Thoracic Surgery ◽

10.4236/ojts.2020.103007 ◽

2020 ◽

Vol 10 (03) ◽

pp. 69-79

Author(s):

Marios Patronis ◽

Jonathan Unsworth-White ◽

James Kuo

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Thoracic Aorta ◽

Type A ◽

Ascending Aorta ◽

Acute Type ◽

Frozen Elephant Trunk ◽

Descending Thoracic Aorta ◽

Elephant Trunk ◽

Type A Aortic Dissection

Download Full-text

Frozen Elephant Trunk in Aortic Arch Disease: Different Devices for Different Pathologies

Medicina ◽

10.3390/medicina57101090 ◽

2021 ◽

Vol 57 (10) ◽

pp. 1090

Author(s):

Carlo Mariani ◽

Giacomo Murana ◽

Alessandro Leone ◽

Luca Di Di Marco ◽

Davide Pacini

Keyword(s):

Aortic Arch ◽

Thoracic Aorta ◽

Stent Graft ◽

Intramural Hematoma ◽

Distal Anastomosis ◽

Frozen Elephant Trunk ◽

Descending Thoracic Aorta ◽

Elephant Trunk ◽

Remarkable Feature ◽

Early Results

The frozen elephant trunk technique (FET) requires the use of a pre-assembled hybrid prosthesis consisting of a standard Dacron vascular portion to replace the aortic arch and a stent graft component, which is placed into the proximal descending thoracic aorta (DTA) anterogradely in the proximal descending thoracic aorta. In Europe, two hybrid prostheses are available: the E-evita Open Plus hybrid stent graft system provided by JOTEC (Hechingen, Germany) and the ThoraflexTM Hybrid (Vascutek, Inchinnan Scotland). Recommendations for use are extensive pathologies of the arch in case of acute and chronic aortic dissection, degenerative aneurysm and intramural hematoma. The FET approach allows the replacement of the whole arch in one stage with the option of direct treatment of the proximal descending thoracic aorta based on the stent component, creating a safe landing zone for further endovascular treatment more distally. The remarkable feature of this technique is the possibility to perform more proximally (from zone 3 to zone 0) the distal anastomosis in to the arch. This allows for an easier distal anastomosis, reduced hypothermic circulatory arrest time and decreased risk of paraplegia (<5%). Early results are promising and according to the most recent series the rate of developing post-operative renal insufficiency ranges from 3 to 10%, the risk of stroke from 3% to 8% and mortality from 8–15%. The aim of the article will be to provide some knowledge about the use and application of FET procedures in different aortic situations.

Download Full-text

Treating the patient with acute rupture of penetrating atherosclerotic ulcer of the thoracic aorta

Kazan medical journal ◽

10.17750/kmj2015-377 ◽

2015 ◽

Vol 96 (3) ◽

pp. 377-380

Author(s):

I R Yagafarov ◽

R R Sayfullin ◽

M M Iskhakov ◽

N V Gazizov ◽

M G Khatypov ◽

...

Keyword(s):

Aortic Arch ◽

Thoracic Aorta ◽

Spontaneous Rupture ◽

Open Surgery ◽

Intraoperative Complications ◽

Long Term Results ◽

Safe Procedure ◽

Descending Thoracic Aorta ◽

Prosthetic Repair ◽

Penetrating Atherosclerotic Ulcer

Spontaneous rupture of the aorta - a violation of the integrity of the aortic wall which is not caused by an aneurysm, trauma, dissection or disintegrating tumor process, and is an acute life-threatening condition. According to some authors, the main cause of spontaneous rupture of the aorta is a penetrating atherosclerotic ulcer of the aorta, which is an ulceration of aortic atherosclerotic plaque leading to penetration of the internal elastic plate in media. We present a case of successful hybrid surgical treatment of patient with spontaneous rupture of the descending thoracic aorta with the formation of para-aortic hematoma and left-sided hemothorax. The patient underwent a hybrid operation - aortic arch and descending thoracic aorta prosthetic repair, subclavian bypass with left subclavian artery ligation, left-sided thoracotomy, and pleural cavity sanitation. No intraoperative complications were observed, the patient was taken off the ventilator on day 2. The control computed tomography performed on day 10, revealed correct and stable stent graft position with no signs of continued bleeding, endoleak. The patient was discharged in satisfactory condition on day 14. Due to the high hospital mortality of open surgery on the thoracic aorta in case of penetrating atherosclerotic ulcers, as well as the predominance of elderly patients with severe comorbidities that contraindicate open surgery using cardiopulmonary bypass, endovascular and hybrid technologies, which are minimally invasive and traumatic, come to the fore. Endovascular prosthetic repair in case of penetrating atherosclerotic ulcer of aortic arch and descending thoracic aorta is an effective and safe procedure in patients at high risk, showing encouraging long-term results.

Download Full-text