Fig. 1 A completed aortic arch replacement using a trifurcated graft technique modified as an elephant trunk repair. With this technique, the brachiocephalic vessels are rerouted, and the distal anastomosis is created proximal to the origin of the left common carotid artery. The distal edge of the elephant trunk is marked with surgical clips to facilitate the second stage of the repair.

© 2009 by Baylor College of Medicine, Dr. Joseph Coselli. Used by permission.