Advances in treatment of extensive aortic aneurysms

摘要

Surgical treatment of combined pathologies of the ascending aorta, aortic arch and the descending aorta still makes great demands on the surgeon. In 1983 Borst et al. established the elephant trunk procedure for treatment of such complex aortic aneurysms, which subsequently became the recognized standard procedure and has simplified the surgical treatment of these pathologies. The frozen elephant trunk technique (hybrid procedure) was recently introduced as an extension of this procedure. This procedure permits the single-stage definitive treatment of intersegmental aneurysms extending over the ascending aorta, the aortic arch and the descending aorta via transmediastinal sternotomy using a new type of prosthetic bypass graft with stent portion, which is inserted anterograde in the descending aorta. The aortic arch and, if necessary, the ascending aorta are subsequently replaced in the conventional manner. The new procedure can be implemented with a risk probability which is comparable to that of the elephant trunk technique. The main advantage is that this is a single-stage approach and the second stage which is necessary by the conventional approach can be omitted. Although the surgical strategy is oriented to the individual pathology of each patient, the frozen elephant trunk technique could replace the previous conventional procedure as the treatment standard for extensive aortic aneurysms.