Distal graft anastomosis using a tapered elephant trunk in an inflammatory aneurysm

Graft replacement of an inflammatory abdominal aortic aneurysm is rather troublesome due to the marked adhesion to surrounding organs and thickened wall, which is mostly too hard and inflexible to allow the artery to be fitted to a prosthetic graft. For one such case, we developed a novel and unique technique for a distal anastomosis using a tapered elephant trunk. This technique was designed on the assumption of further aneurysmal changes and enabled us to create a secure anastomosis at the enlarged inflammatory part of the common iliac artery. The distal flow to both the external and internal iliac arteries was well maintained without any complications.