Rare complication: refractory hypertension and intermittent claudication caused by elephant trunk entrapped in a new entry after total arch replacement for type A aortic dissection.

BACKGROUND: Total arch replacement using elephant trunk (ET) has been accepted as a standard technique for thoracic aortic dissection. However, there are few complications related to the ET, such as kinking of the ET, paraplegia, splitting of the anastomosis, and thromboembolic complications. We report a successful thoracic endovascular aortic repair (TEVAR) in a patient with ET entrapment in a new isolated dissecting aortic aneurysm.

CASE PRESENTATION: A 50-year-old woman who underwent total arch replacement (TAR) with the ET technique 6 years ago was admitted with refractory hypertension and heart failure. Magnetic resonance angiography revealed that the ET was entrapped in an isolated dissecting aortic aneurysm, which obstructed blood flow, thus causing ischemia. She underwent TEVAR to reset the entrapment of the ET. After TEVAR, ischemic symptoms were immediately relieved.

CONCLUSION: We present a case of new entry after the repair of a type A acute aortic dissection using ET, which rapidly progressed to a distal arch dissecting aneurysm and dislocation of the ET.