ArticleJTCVS techniques2021
Arch replacement with collared elephant trunks: The Siena approach.
Article in JTCVS techniques, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 8 citations in OpenAlex.
- The development of the Siena graft.Annals of cardiothoracic surgery · 2025Review
- Hybrid repair with soft elephant trunk for acute type B dissection in a patient with right-sided aortic arch and Kommerell diverticulum.JTCVS structural and endovascular · 2025Article
- Hybrid Endovascular and Open Interventions for Aortic Disease.Seminars in interventional radiology · 2024Review
- Extra-anatomical left common carotid and subclavian artery bypass followed by aortic arch replacement with frozen elephant trunk.Journal of cardiothoracic surgery · 2023Article
- Transapical total aortic arch replacement with three-branched endograft for penetrating aortic ulcer.Journal of vascular surgery cases and innovative techniques · 2023Article
- Commentary: Where does your distal aortic anastomosis lead to?JTCVS techniques · 2021Article
- Commentary: Should we freeze the elephant trunk with or without stents?JTCVS techniques · 2021Article
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo illustrate our experience and results in patients with diffuse aneurysmal disease treated with arch replacement using the Siena collared graft, a device designed in 2002 to improve the elephant trunk technique. Results of the first step surgical implant and the subsequent treatment strategies, with extensive use of endovascular techniques, are reported.
methodsAll aortic arch-replacement procedures using the Siena graft between February 2002 and January 2020 were retrospectively analyzed for early and late clinical outcomes.
resultsOf 146 patients (54 women, 36.9%) with a median age of 69.1 years (interquartile range 58.4-75.0 years), 55 (37.6%) had acute/chronic dissection with false lumen aneurysmal dilatation, 91 (62.3%) had degenerative aneurysms, 45 (30.8%) were redo operations, and 14 (9.5%) had connective tissue disease. First-stage outcomes: 10.9% 30-day mortality (n = 16); 5.4% stroke (n = 8, 6 disabling, 2 nondisabling; 3 fatal); and 0.6% paraplegia. Outcomes for 113 second-stage procedures (77.3%, n = 97 endovascular [66.4%], n = 16 surgical [10.9%]) were 5.3% and 8.8% 30-day and 180-day mortality; no stroke; 10.6% paraplegia. Median follow-up was 5.7 years (range: 0-18.02 years) median survival was 16.65 years (95% lower confidence limit, 10.06 years) with no significant difference between aneurysm and dissection patients. Freedom from further treatment was 87.0% (95% confidence interval, 79.9%-94.7%) at 5 years and 71.4% (95% confidence interval, 71.4%-84.7%) at 10 years; median time to reintervention was 2.59 years (interquartile range, 0.52-5.20 years) with no difference (
conclusionsSiena collared graft represents a reliable platform for the treatment of diffuse aneurysmal disease. This device offers the flexibility required in the treatment of extended aortic lesions and guarantees the choice of the most appropriate approach for treatment completion. In this context, the availability of hybrid grafts has not modified the role of this device in arch surgery.
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