Elephant trunks in aortic surgery: fresh and frozen

Aneurysmal diseases are often silent but can cause potentially life-threatening complications in cases of dissection or rupture. Surgical strategies depend on the involved part of the aorta and frequently require extracorporeal circulation and circulatory arrest. From data available from the Centers for Disease Control and Prevention, aneurysm disease is the 18th most common cause of death in all individuals, and the incidence is certain to increase as our population ages. This article discusses different treatment options introduced in the past few decades to address multifocal pathologic conditions of the thoracic aorta. These include the conventional elephant trunk procedure introduced by Hans Borst in 1983, with several modifications, and also hybrid procedures combining open surgical and endovascular techniques: the so-called frozen elephant trunk. Advantages and drawbacks of both techniques will be discussed based on personal and practical perspectives, with specific mention of the elephant trunk procedure in acute aortic dissections.