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Online ISSN 1827-1847
ENDOVENOUS TREATMENT OF VARICOSE VEINS
Patel S. D., Constantinou J., Hamilton H., Ivancev K.
Department of Vascular Surgery, Royal Free Hospital NHS Foundation Trust, London, UK
Open surgery is considered to be the gold standard when treating aortic arch disease. Despite recent advances in open surgical techniques, it continues to be associated with significant morbidity and mortality, and is a procedure for which many are not deemed suitable. The advent and gradual progression of endovascular repair offers hope of an endovascular solution to treating arch pathology. Here we review the options for managing aortic arch disease and in particular the emerging endovascular techniques. We review the current results of open, hybrid, and totally endovascular arch repair. The latter involves chimney graft repair, in situ fenestration and stenting or insertion of the arch branch device. The inner branched arch endograft (Cook) is the latest generation of arch graft which is inserted via the transfemoral route. It has a number of features such as a precurved cannula, spiral trigger wires and diameter reducing ties which help it overcome the unique challenges that the aortic arch poses to endovascular repair. World wide experience is currently limited to 38 patients in 10 centers, with a technical success rate of 84%. We outline tips to the successful measurement and deployment of the endograft and review potential complications. We conclude that the overall results of the arch branch device are comparable with both open and hybrid repair. It must be remembered that the group of patients treated with the arch branch device were those deemed too high risk for other forms of repair, which make the results all the more encouraging.