[Aortic arch replacement with covered stent-graft as elephant trunk for a type A acute aortic dissection]

We report a case of aortic arch replacement with a covered stent-graft as an "elephant trunk". A 54-year-old woman was diagnosed with Stanford type A aortic dissection. The initial intimal tear was located in the distal aortic arch. Under deep hypothermic circulatory arrest and retrograde cerebral perfusion, the distal end of the arch graft, which was turned inside out and reinforced with a Z-stent, was inserted into the distal true lumen as an "elephant trunk". Distal anastomosis was performed between the aortic wall and the inverted external graft. Graft replacement of the aortic arch and ascending aorta was followed by proximal arch grafting. Coronary artery bypass grafting to RCA was performed concomitantly. The postoperative course was uneventful, and the distal false lumen became thrombosed. This procedure is effective for reliable distal anastomosis and prevention of blood leakage into the distal false lumen.