The elephant trunk operation in complex aortic disease

Extensive aneurysmal disease of the aorta presents considerable challenges to the cardiovascular surgeon and is generally treated with a staged approach. The elephant trunk principle, in which the downstream end of the primarily inserted graft is allowed to float freely in the downstream aorta, serves this approach. This principle greatly facilitates subsequent operation(s) and shortens the period of distal aortic occlusion. This review describes the state of the art of this technique, its various uses, and the results obtained.