Aortic arch replacement and elephant trunk method for thoracic aneurysm

: A 73-year-old female with ischemic heart disease and thoracic aneurysm from the ascending aorta to the descending aorta underwent coronary bypass and aortic arch replacement combined with the elephant trunk method with the aid of extracorporeal circulation and selective cerebral perfusion. The graft provided with four limbs for arch replacement was inverted in advance. The ascending aorta was cross-clamped following extracorporeal circulation. The anastmosis of the left internal thoracic artery to LAD was continuously performed by 8/0 prolene. As the elephant trunk 11 cm in length of the inverted graft was inserted into descending aorta after the arch and descending aorta were opened. The inverted end of the graft was sutured to the aorta beyond the origin of the left subclavian artery. The inverted end of graft with four limbs was then withdrawn. Brachiocephalic vessels were reconstructed during rewarming. The patient recovered well without any cerebral complications. Aortogram made after operation showing proximal aortic replacement and a segment dangling in the distal aneurysm surrounded with thrombus.