[Total arch replacement using a long elephant trunk for chronic dissecting aneurysm of a distal aortic arch]

A 74-year-old man was diagnosed with Stanford type B early thrombosed aortic dissection. Computed tomography (CT) 2 years later revealed that an aneurysm of the distal arch had enlarged from a maximal diameter of 47 mm to 62 mm and involved the descending aorta. Total arch replacement using a quadrifurcated arch graft proceeded through a median sternotomy under deep hypothermic cardiopulmonary bypass (20 degrees C) and selective brain perfusion. The long elephant trunk of another prosthesis was inserted into the descending aorta and a distal anastomosis was constructed immediately after the left common carotid artery. The post-operative course was uneventful and CT at that time revealed complete thrombo-exclusion of the aneurysm surrounding the long elephant trunk. This method was very useful for reducing the duration of circulatory arrest and bleeding, as well as the risk of postoperative complications.