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Related Experiment Video

Updated: Oct 26, 2025

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Arch replacement with collared elephant trunks: The Siena approach.

Eugenio Neri1, Luigi Muzzi1, Enrico Tucci1

  • 1Aortic Surgery Unit, Siena University Hospital, Siena, Italy.

JTCVS Techniques
|July 28, 2021
PubMed
Summary

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The Siena collared graft is a reliable device for treating diffuse aortic aneurysmal disease, offering flexibility for complex aortic lesions. It facilitates tailored treatment strategies, including endovascular techniques, with good long-term outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Thoracic Surgery

Background:

  • Diffuse aneurysmal disease of the aortic arch presents complex treatment challenges.
  • The Siena collared graft was designed to enhance the elephant trunk technique for aortic arch replacement.
  • Hybrid approaches combining surgical and endovascular methods are increasingly used.

Purpose of the Study:

  • To evaluate the clinical experience and outcomes of aortic arch replacement using the Siena collared graft.
  • To assess the efficacy of the Siena graft in managing diffuse aneurysmal disease, including dissection and degenerative aneurysms.
  • To report on the outcomes of both the initial surgical implant and subsequent endovascular treatments.

Main Methods:

  • Retrospective analysis of all aortic arch replacement procedures using the Siena graft from February 2002 to January 2020.
Keywords:
CI, confidence intervalCSF, cerebrospinal spinal fluidCT, computed tomographyET, elephant trunkIQR, interquartile rangeLCL, lower confidence limitOR, odds ratioOSR, open surgical repairPAU, penetrating aortic ulcerSINE, stent graft–induced new entry tearTEVAR, thoracic endovascular aortic repairaortaaortic arch surgeryelephant trunk techniquethoracic endovascular repair

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  • Inclusion of patients with diffuse aneurysmal disease, including acute/chronic dissection and degenerative aneurysms.
  • Evaluation of early and late clinical outcomes, including mortality, stroke, paraplegia, and reintervention rates.

    • Main Results:

    • 146 patients underwent aortic arch replacement with the Siena graft; 37.6% had dissection, 62.3% degenerative aneurysms.
    • First-stage outcomes included 10.9% 30-day mortality, 5.4% stroke, and 0.6% paraplegia.
    • Second-stage procedures (77.3%), predominantly endovascular, showed 5.3% 30-day and 8.8% 180-day mortality, with no stroke but 10.6% paraplegia.
    • Median survival was 16.65 years, with 5-year and 10-year freedom from further treatment at 87.0% and 71.4%, respectively.

    Conclusions:

    • The Siena collared graft is a reliable platform for treating diffuse aneurysmal disease of the aortic arch.
    • The device provides flexibility for extended aortic lesions, allowing for optimal treatment strategies, including hybrid approaches.
    • The Siena graft remains a valuable option in arch surgery, even with the advent of hybrid grafts.