USGabdomen showed that stents were extracted fromthe patient.
Fundus with cystogastrostomy stent insitu
Endoscopic ultrasound (EUS) showed pseudocystin closed opposition to fundus and body of stomachwith few prominent vessels. Options were to performlaparoscopic/open/EUS guided pseudocyst drainage.Pseudocyst was drained by puncturing with a 19 Gneedle away from collateral and about 800cc
uid wasdrained.Close follow-up on USG showed total collapse andstents were extracted 6 weeks later (see Fig 2). Poststent extraction USG’s over last 4 months did not revealany recurrence. Patient was asymptomatic.Conclusion: Post cystogastrostomy status stentextraction done
Endoscopic ultrasound offers excellent servicing for draining pseudocysts as it is minimally invasive, avoids vessels in thetrack. Unlike routine endoscopic drainage pseudocysts whichdo not indent stomach/duodenum can safely be drained withEUS. Liver abscess subphrenic abscesses and biliomos canalso be drained apart from
ne needle aspiration cytology (FNAC) of various lesions in GIT as well as organs in closejuxtaposition.
Pancreatic pseudocyst and Its Management
For further details you can contact:
Dr. D Srinivasa91 80 4199 4444
The head vessels were reconnected and the circulationwas restarted and patient was re-warmed to 36
C.It is known as an elephant trunk procedure becausethe remaining part of the graft is left hanging in thedescending aorta to help in its replacement when thepatient comes back for the stage 2 procedure after3-4 months.
Stage 2 Frozen Elephant trunk procedure
Replacement of the descending thoracic aorta:
The replacement of the descending thoracic aorta startingfrom distal to the origin of the subclavian artery to the 10
thoracic vertebral level was done. This was accomplishedwith a endovascular stent graft (see Fig. 4). The procedureis known as Frozen elephant trunk as it is accomplishedin a single sitting and is a hybrid approach to a problemwhich has high mortality and morbidity (see Fig. 5).
Post operative care
The patient was discharged from the hospital on day 7after her aorta was
xed. A repeat CT angiogram wasdone to document the position of the stent graft and tocon
rm that there are no leaks of any kind.
The treatment of complex aortic pathology representsa surgical challenge, with high post operativemorbidity and mortality rates.
Elephant trunk is atechnique which uses excess intravascular graft lengthto facilitate subsequent operations to facilitate the
Replacement of the ascending aorta and aortic arch
subsequent treatment of distal aortic aneurysms. Itgreatly facilitates and at the same time reduces the riskof multiple-stage aortic replacement.
It offers severaladvantages such as saves the proximal graft-to-aortaanastomosis, at the same time avoids dangerouscomplications at the previous anatomic site. Besides,it also reduces the time of aortic occlusion in simpleclamping to that needed for the distal anastomosis.
This procedure has improved the results of complexreplacement of the ascending aorta, aortic arch anddistal aorta and has resulted in better survival ratesthan those of traditional approaches.
Aortic Dissection and Its Management with Frozen Elephant trunk procedure
1. Lus F, Hagl C, Haverich A,
. Elephant trunk procedure 27 years after Borst: Whatremains and what is new?
Eur J Cardio-thoracic Surg
. 2011;40:1-12.2. Heinemann MK, Buehner B, Jurmann MJ,
. Use of elephant trunk technique inaortic surgery.
Ann Thorac Surg
. 1995;60(1):2-6.3. Svensson LG. Rationale and technique for replacement of the ascending aorta,arch, and distal aorta using a modi
ed elephant trunk procedure.
J Card Surg
For further details you can contact:
Dr. Mohammed Rehan Sayeed91 80 4199 4444/6621 4444
Frozen Elephant trunk procedure