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Pseudocoarctation following elephant trunk intervention.

Joseph F Zywiciel¹, Manuel Rojo², Jeffrey Schwartz²

¹Loyola Stritch School of Medicine, Maywood, IL.

Journal of Vascular Surgery Cases and Innovative Techniques

|February 2, 2024

Summary

Aortic arch surgery using the elephant trunk technique can lead to pseudocoarctation. This complication, characterized by graft compression, was successfully treated with thoracic endovascular aneurysm repair.

Keywords:

Aortic disease Conventional elephant trunk Pseudocoarctation

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Area of Science:

Cardiovascular Surgery
Vascular Surgery
Thoracic Surgery

Background:

The conventional elephant trunk technique is a common method for aortic arch replacement.
This technique involves placing a graft within the true lumen of the aorta.

Observation:

A 55-year-old male developed pseudocoarctation of the descending aorta after aortic arch replacement with the elephant trunk technique.
Postoperative complications included rising creatinine, hemolysis, and toe cyanosis.
A significant systolic pressure gradient was detected between radial and femoral arteries.

Findings:

Computed tomography angiography confirmed compression of the elephant trunk graft within the true lumen.
This compression resulted in a pseudocoarctation of the descending aorta.

Implications:

Pseudocoarctation is a potential complication of the elephant trunk technique.
Thoracic endovascular aneurysm repair offers a successful treatment option for this complication.