The frozen elephant trunk technique

Abstract

The so-called 'frozen elephant trunk' technique is adapted from the classical elephant trunk technique first described by H.G. Borst in 1983 and allows the repair of concomitant aortic arch and proximal descending aortic aneurysms in a single stage. A 'hybrid' vascular graft consisting of a conventional tube graft with an endovascular stented graft at the distal end is utilised to achieve a blood-tight seal in the descending aorta that cannot easily be accessed directly from an anterior approach. Thus, the concept of a traditional elephant trunk, otherwise completed with a secondary endovascular or surgical procedure, is achieved in one single step. First intra- and postoperative results of this technique in terms of successful exclusion of the proximal descending aortic aneurysm are good and following the learning curve, the prolongation of circulatory arrest and cerebral perfusion, as compared to the traditional elephant trunk procedure, is within minutes and thus acceptable. Currently all patients with thoracic aneurysms extending from the arch beyond the left subclavian artery are evaluated for this treatment at our institution. Furthermore, acute aortic dissections (type A and B) are an area of intensive clinical evaluation at present.