REVIEWS  NEW DEVELOPMENTS IN THE TREATMENT OF AORTIC ARCH LESIONS AND DISSECTIONS 

The Journal of Cardiovascular Surgery 2016 June;57(3):421-36

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

Techniques for aortic arch endovascular repair

Kiattisak HONGKU, Nuno DIAS, Bjorn SONESSON, Timothy RESCH ✉

Skane University Hospital, Malmö, Sweden

This article reviews endovascular strategies for aortic arch repair. Open repair remains the gold standard particularly for good risk patients. Endovascular treatment potentially offers a less invasive repair. Principles, technical considerations, devices and outcomes of each technique are discussed and summarized. Hybrid repair combines less invasive revascularization options, instead of arch replacement while extending stent-graft into the arch. Outcomes vary with regard to extent of repair and aortic arch pathologies treated. Results of arch chimney and other parallel graft techniques perhaps make it a less preferable choice for elective cases. However, they are very appealing options for urgent or bailout situations. Fenestrated stent-grafting is subjected to many technical challenges in aortic arch due to difficulties in stent-graft orientation and fenestration positioning. In situ fenestration techniques emerge to avoid these problems, but durability of stent-grafts after fenestration and ischemic consequences of temporary carotid arteries coverage raises some concern total arch repair using this technique. Arch branched graft is a new technology. Early outcomes did not meet the expectation; however the results have been improving after its learning curve period. Refining stent-graft technologies and implantation techniques positively impact outcomes of endovascular approaches.