Erosion of elephant trunk Dacron graft limb by thoracic endograft causing acute aneurysm expansion

We recently treated a patient in whom a Gore TAG thoracic endograft (W.L. Gore and Assoc, Flagstaff, Arix) had been used to repair a descending thoracic aneurysm as the second stage of a hybrid procedure. This patient had previously undergone repair of ascending and aortic arch aneurysms, with an elephant trunk graft limb placed in the descending thoracic aorta for subsequent repair of the descending thoracic aneurysm. Eight months after placement of the thoracic endograft, the patient presented with an acutely expanding and symptomatic thoracic aneurysm. The patient was operated on urgently. The proximal portion of the endograft had eroded into the previously placed Dacron elephant trunk limb. The proximal portion of the endograft was removed and was replaced with a Dacron graft. The management of this patient forms the basis of this report.