The reversed elephant trunk procedure uses an inverted graft for distal aortic replacement before aortic arch replacement in patients with mega aorta, to reduce the risk in the second stage. However, the conventional technique restricts the maximum diameter of the inverted graft to the aortic graft diameter. We employed a beveled reversed elephant trunk procedure to overcome the discrepancy between graft diameters in a 54-year-old woman with a severely twisted ascending aortic graft and enlarging chronic dissection of the aortic arch and descending thoracic aorta. The patient was discharged with a satisfactory repair and no neurologic deficit.
BavariaJVallabhajosyulaPMoellerPSzetoWDesaiNPochettinoA. Hybrid approaches in the treatment of aortic arch aneurysms: postoperative and midterm outcomes. J Thorac Cardiovasc Surg2013; 145: S85–S90.
2.
MadenciALOzakiCKBelkinMMcPheeJT. Carotid-subclavian bypass and subclavian-carotid transposition in the thoracic endovascular aortic repair era. J Vasc Surg2013; 57: 1275–82.e2.
3.
SamuraMZempoNIkedaY. Endovascular repair of distal arch aneurysm with double-chimney technique. Ann Thorac Surg2013; 95: 1778–1780.
4.
HeinemannMKBuehnerBJurmannMJBorstHG. Use of the “elephant trunk technique” in aortic surgery. Ann Thorac Surg1995; 60: 2–6.
5.
CoselliJSLeMaireSACarterSAConklinLD. The reversed elephant trunk technique used for treatment of complex aneurysms of the entire thoracic aorta. Ann Thorac Surg2005; 80: 2166–2172.
