Two-Stage Repair With Classic Elephant Trunk and TEVAR for an Extensive Thoracic Aorta Aneurysm

Surgery of the thoracic aorta is a great challenge for cardiovascular surgeons. Refined surgical techniques and organ protection methods allow complex diseases of the thoracic aorta to be treated with favorable results. In this setting, a thorough assessment of the aortic anatomy and a patient’s comorbidities is mandatory to adequately decide upon the extent of the operation and to plan the most appropriate surgical strategy.

In this video, the authors present the case of a patient with an extensive thoracic aorta aneurysm, who was treated with a two-stage hybrid approach. The patient initially underwent total arch replacement with classic elephant-trunk technique using a 30 mm Vascutek Siena graft. Antegrade selective cerebral perfusion with moderate hypothermia was used for cerebral protection. Three months later, complete endovascular exclusion of the remaining thoracic aorta was performed. Both postoperative courses were uneventful, and the patient remained well at the 6-month follow-up visit, with unchanged aortic appearances and stable aortic diameters.