Elephant graft repair

An elephant trunk repair is a type of open repair procedure devised to address combined aneurysms, it  is often a two staged procedure wherein the arch repair is facilitated by sternotomy and a second staged procedure is performed via left thoracotomy for the descending or thoracoabdominal aorta.

Complications

• typical aortic surgery complications
  • risk of graft occlusion
  • graft kinking
  • neurologic dysfunction (stroke, encephalopathy, spinal cord injury)
  • mediastinitis
  • renal insufficiency
  • need for tracheostomy
  • hemorrhage
• unique complications related to the configuration of the elephant trunk
  • clot formation around the free end of the elephant trunk
  • peripheral thromboembolism due to graft flapping
  • left recurrent laryngeal nerve paralysis
  • vocal cord paralysis
  • entrapment of the free end of the graft within the true or false lumen, eliminating flow in the other lumen and perfusion of the abdominal branches that arise from that lumen

Prognosis

Some publications have suggested high survival rates ranging around 98% for the first operation and 92% for the second.

History and etymology

It was devised in 1983 by Hans Borst and colleagues.