Single-stage repair of arch aneurysms with a long elephant trunk: Medium-term follow-up of thromboexcluded aneurysms

Objectives 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.