USE OF THE ELEPHANT TRUNK TECHNIQUE IN AORTIC-SURGERY

Background. In aortic replacement, the ''elephant trunk technique'' us es surplus intravascular graft length to facilitate subsequent operati ons on the downstream aorta. This study investigates the experience wi th the technique since its conception by our group. Methods. Between 1 982 and 1994, 80 elephant trunks were implanted in 72 patients. In 40 cases the primary position was in the proximal descending thoracic aor ta, extending an aortic arch graft. In 32 instances the elephant trunk was placed in the distal descending thoracic aorta extending descendi ng aortic replacement. Aortic pathology comprised aneurysms in 22 case s, chronic dissection in 47, and acute dissection in 3. Fourteen patie nts had Marfan's syndrome. Results. There was a total of 10 early deat hs, 7 of which occurred during the early experience. Subsequent downst ream aortic operation was undertaken in 24 patients after a mean inter val of 14 months, replacing the descending thoracic aorta in 17 cases and the thoracoabdominal portion in 7 cases. Six patients underwent th ird-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 red uces the risk of multiple-stage aortic replacement.