Endovascular repair of the aortic arch: State of the art.
BACKGROUND
Open total arch replacement remains the gold standard treatment for aneurysms and dissections involving the aortic arch. However, high-risk surgical candidates may benefit from endovascular techniques to reduce the risk of perioperative mortality and morbidity, especially neurologic complications. Numerous endografts are available for investigational use in the aortic arch as part of investigational device exemption (IDE) programs. Some devices are fenestrated or scalloped, while others are branched, ranging from single branch to triple branch stent-grafts. Furthermore, chimney techniques and in situ fenestration may be utilized in bailout or emergent situations.


RESULTS
Initial results describing outcomes of complete endovascular repair of the aortic arch are encouraging, with current data estimating that technical success ranges from 84.2% to 100%. Moreover, operative mortality may be as high as 13.2%, while neurologic complications also remain common, with stroke rates being as high as 20% and spinal cord ischemia being as high as 3.1%. However, more data are necessary to determine the comparative treatment effect of endovascular stent-grafting of the aortic arch, compared with conventional open and hybrid repairs. Longitudinal follow-up is also lacking, which will determine the long-term durability of endografts in the aortic arch. Nevertheless, endovascular repair represents an important opportunity for improving outcomes in patients with complex and potentially devastating pathologies of the aortic arch.
['Brown|James A|JA|', 'Arnaoutakis|George J|GJ|http://orcid.org/0000-0002-7648-0747', 'Szeto|Wilson Y|WY|', 'Serna-Gallegos|Derek|D|http://orcid.org/0000-0002-5991-6385', 'Sultan|Ibrahim|I|http://orcid.org/0000-0002-1737-4012']
D017545:Aortic Aneurysm, Thoracic D001807:Blood Vessel Prosthesis D019917:Blood Vessel Prosthesis Implantation D057510:Endovascular Procedures D006801:Humans D011183:Postoperative Complications D011474:Prosthesis Design D012307:Risk Factors D015607:Stents D016896:Treatment Outcome
total arch replacement aorta aortic aneurysm aortic dissection hybrid aortic procedures thoracic endovascular aortic repair