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Ann Thorac Surg 1995;60:7
© 1995 The Society of Thoracic Surgeons

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J. Maxwell Chamberlain Memorial Paper

Discussion

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DR RANDALL B. GRIEPP (New York, NY): The elephant trunk procedure is one of those things that elicits the response: ``Of course! How very obvious! How appropriate to the problem. And why couldn't I have thought of that?'' Soon after it was described by Dr Borst in 1983, the elephant trunk was rapidly incorporated into the armamentarium of most aortic surgeons. It is clearly a major advance in dealing with the patient who, in addition to an arch aneurysm, has an aneurysm in the descending thoracic aorta, the distal extent of which cannot be reached easily.

I would like to emphasize some of the points Dr Heinemann made with regard to technical factors. Putting the doubled graft down inside the descending thoracic aorta certainly simplifies the procedure. One then can work very easily on the distal anastomosis of the first stage. One can put Teflon felt around it if needed for a friable aorta, or transect the aorta; there are a number of possible variations. Once the distal anastomosis is complete, . . . [Full Text of this Article]

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Ann. Thorac. Surg. 1995 60: 235-494.