Thoracic aorta injury caused by blunt chest trauma is often fatal. A 26-year-old male with bilateral pneumohemothorax and disruption of the thoracic descending aorta due to a traffic accident was referred to our hospital. The chest X-ray film and CT scanning showed neither mediastinal widening nor periaortic hematoma. Three weeks after admission, aortography revealed flap formation at the aortic isthmus. Two months after trauma, we replaced the injured aorta with a vascular prosthesis using a centrifugal pump. Pathological examination showed separation of a medial layer of the aorta. His postoperative course was uneventful.

We report a 78-year-old man who had an impending ruptured atherosclerotic arch aneurysm combined with chronic dissecting ascending aortic aneurysm. The patient underwent a graft replacement of the ascending aorta and aortic arch using the elephant trunk method with the aid of profound hypothermia and continuous retrograde cerebral perfusion. Cerebral blood velocity was measured with transcranial Doppler (TCD) during operation. The TCD flow pattern after weaning of cardiopulmonary bypass indicated a state of brain edema. Therefore it is important in extensive retrograde cerebral perfusion to control the perfusion pressure and prevent destruction of the blood brain barrier aggressively. Pharmacological intervention could improve the safety of retrograde cerebral perfusion. Postoperative diagnostic images showed that the part of the distal anastomosis around the elephant trunk was not surrounded with thrombus. At this stage, it is not necessary to perform next extensive aortic replacement. It is important to consider the occurrence of complication, who using elephant trunk method, including paraplegia, thromboembolism, kinking of prothesis.