Total debranching thoracic endovascular aortic repair with elephant trunk insertion technique.

We report successful total debranching thoracic endovascular aortic repair using the elephant trunk insertion technique without hypothermic circulatory arrest for a 56-year-old man who developed aortic arch dissection and ascending aortic aneurysm. In the first step, an elephant trunk graft was inserted into the ascending aorta under cardiopulmonary bypass, and a branched prosthetic graft was attached to the ascending aorta. The left common carotid artery and brachiocephalic artery were sequentially anastomosed to the branched graft. The second step was thoracic endovascular aortic repair covering the elephant trunk to the distal arch. Postprocedure digital subtraction angiography showed no endoleaks or false lumen.