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Updated: May 22, 2026

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Surgery for type B dissection using a short-stented elephant trunk procedure.

LiangXin Tian1, RuiDong Qi, Qian Chang

  • 1Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.

The Heart Surgery Forum
|May 1, 2012
PubMed
Summary

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Proximal descending thoracic aorta replacement with a short-stented elephant trunk is a viable treatment for type B aortic dissection when endograft fixation is inadequate. This procedure promotes true lumen expansion and false lumen thrombosis, though spinal cord injury remains a concern.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Thoracic Surgery

Background:

  • Type B aortic dissection management often involves stent grafting.
  • Inadequate proximal or distal fixation zones can preclude endograft repair.
  • Alternative surgical strategies are needed for complex cases.

Purpose of the Study:

  • To evaluate the efficacy of proximal descending thoracic aorta replacement combined with short-stented elephant trunk implantation.
  • To assess this technique in type B aortic dissection patients lacking adequate endograft fixation zones.

Main Methods:

  • Retrospective review of 21 patients (10 acute, 11 chronic) with type B dissection.
  • Procedure involved proximal descending thoracic aorta replacement followed by short-stented elephant trunk implantation.

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  • Post-operative computed tomography (CT) scans assessed the residual false lumen.

    • Main Results:

    • No in-hospital mortality; one late death during a mean 69-month follow-up.
    • High rates of false lumen thrombosis (95%) and diaphragmatic level thrombosis (85%) observed.
    • Complications included transient paraparesis, paraplegia in one patient, and cerebral hemorrhage in one patient.

    Conclusions:

    • This combined surgical approach is a suitable alternative for type B dissection patients unsuitable for endografts.
    • The technique facilitates true lumen enlargement, re-establishment, and false lumen thrombosis.
    • Spinal cord injury remains a significant, intractable complication.