A 67-year-old man who had undergone total arch replacement (TAR) using the conventional elephant trunk (ET) technique for acute aortic dissection 10 years ago was admitted owing to congestive heart failure with severe aortic valve regurgitation. Mechanical ventilation and dialysis were required. Computed tomography (CT) revealed that the ET in the distal aortic arch was obstructed and the entering flow into the false lumen emerged beside the distal end of the ET, which had not been found for a decade. He underwent thoracic endovascular aortic repair (TEVAR) to relieve the cardiac afterload. The patient was discharged 20 days postoperatively, free from heart failure and renal dysfunction. We investigated the time-shift morphologic changes of ET through computational fluid dynamics (CFD) analysis. It illustrated that accelerated blood flow and wall shear stress (WSS) were effectively alleviated following TEVAR. Additionally, the accelerated flow and excessive WSS were noted at the time of the TAR procedure 10 years ago, which may have influenced the new ulcer-like projection (ULP).

Keywords: Computational fluid dynamics; Acute aortic dissection; Elephant trunk obstruction