REVIEW  THORACIC AORTIC CHALLENGES 

Italian Journal of Vascular and Endovascular Surgery 2020 March;27(1):38-51

DOI: 10.23736/S1824-4777.20.01451-5

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Current technology for endovascular repair of the aortic arch

Justin M. MILLIGAN, Anand DAYAMA, Hosam F. EL SAYED, Jean M. PANNETON ✉

Division of Vascular Surgery, Department of Surgery, Eastern Virginia Medical School, Norfolk, VA, USA

An open surgical repair is a gold standard for the treatment of aortic arch pathologies. It requires cardiopulmonary bypass, hypothermia, and circulatory arrest and is associated with considerable morbidity and mortality. In prohibitive surgical risk patients, the hybrid approach of supra-aortic debranching, followed by stent-graft deployment, is a valuable alternative. It avoids circulatory arrest and cardiopulmonary bypass. Total endovascular aortic arch repair has emerged as an exciting option in this critically ill patient population with acceptable risk profile but technology is still in infancy and is not available outside a few centers of excellence. The total endovascular aortic arch repair could improve the outcomes of these patients. In this comprehensive overview, we present the current management of the aortic arch pathologies including open, hybrid, and total endovascular arch replacement that includes fenestrated endovascular endograft, multibranched thoracic endografts, and physician-modified fenestration endograft as alternative options.

KEY WORDS: Endovascular procedures; Aorta, thoracic; Technology