Single-stage repair of arch aneurysms with a long elephant trunk: medium-term follow-up of thromboexcluded aneurysms.
OBJECTIVE
The purpose of this study was to investigate the medium-term results of arch aneurysms repaired by total arch replacement with a long elephant trunk and to evaluate whether this technique requires a subsequent distal anastomosis at the descending aorta when complete aneurysmal thrombosis is achieved around a long elephant trunk.


METHODS
From June 1999 through May 2005, 32 consecutive patients with arch aneurysms underwent total arch replacement with a long elephant trunk anastomosed at the base of the innominate artery. Postoperatively, aneurysm size was evaluated by means of serial computed tomographic scanning.


RESULTS
None of the patients experienced a new stroke, although there was 1 (3%) hospital mortality. Computed tomographic scanning demonstrated complete thrombosis of the aneurysm in 29 (91%) patients within 1 month after surgical intervention, and 3 patients with incomplete thrombosis of the aneurysm underwent a subsequent distal anastomosis in the descending aorta. The 3-year survival rate was 87%, with no aneurysm rupture or sudden death. In the 29 patients who showed complete thrombosis of the aneurysm surrounding a long elephant trunk, serial computed tomographic scanning revealed a significant reduction in the size of the thrombosed aneurysm (81% at 1 year and 76% at 2 years after surgical intervention), and there was no case that showed expansion of the aneurysm.


CONCLUSIONS
Arch aneurysms were repaired safely by means of total arch replacement with a long elephant trunk, and successful shrinkage of the arch aneurysm suggests that this technique does not require subsequent distal anastomosis and could turn the 2-stage elephant trunk procedure into a single-stage repair when complete aneurysmal thrombosis is achieved.
Toda
Koichi
K
Department of Cardiovascular Surgery, Japan Labor Health and Welfare Organization Osaka Rosai Hospital, Sakai, Japan. ktoda2002@yahoo.co.jp
Taniguchi
Kazuhiro
K
Hata
Hiroki
H
Shudo
Yasuhiro
Y
Matsue
Hajime
H
Kuki
Satoru
S
Sawa
Yoshiki
Y
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D016122:Brachiocephalic Trunk / Q000601:surgery; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D015996:Survival Rate; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D014057:Tomography, X-Ray Computed