Rapid expansion of another downstream aortic aneurysm with the elephant trunk.

A 75-year-old man developed persistent dysphagia 2 months after successful total arch replacement with a long elephant trunk (ET) for a distal arch aneurysm. Enhanced computed tomography revealed not only complete thrombosis of the distal arch aneurysm, but also rapid expansion of another downstream aortic aneurysm with esophageal compression. Thoracic endovascular aortic repair was undertaken for this symptomatic aortic aneurysm, which was totally thrombo-excluded. ET might produce turbulent or jet-like blood flow from its tip in some situations and have a potential to accelerate the expansion of the downstream aneurysm. Additional endovascular ET completion is simple, effective, and less invasive.