Endovascular Management of Aortic Arch Diseases: Current Status and Future Trends

Abstract

Treatment of aortic arch (AA) diseases is challenging for surgeons. Conventional open surgery remains the “gold standard” but is associated with significant morbidity and mortality despite improvements in techniques. In the last 2 decades, thoracic endovascular aortic repair (TEVAR) has become the first-line treatment for diseases of the descending aorta, and its indications have expanded gradually. Various strategies have been proposed to preserve supra-aortic branches in TEVAR: hybrid technique, chimney technique, fenestration technique (including custom-made fenestrated or “scalloped” stent grafts, in situ fenestration, and physician-modified fenestration), and branched stent grafts. Though acceptable outcomes of endovascular aortic repair have been documented, the evidence regarding its long-term safety and efficacy is lacking, and concerns remain about the risk of cerebrovascular events, retrograde type-A dissection, endoleaks, and branch occlusion. This review discusses the current status and progress of endovascular repair of the AA, and looks toward future trends. We believe that multidisciplinary collaboration of a “HENDO” team (professionals in hybrid repair, endovascular repair, open surgery, cardiovascular anesthesia, and genetics) is essential for future repair of the AA to provide the optimal treatment.

Clinical comparative analysis of 3D printing-assisted extracorporeal pre-fenestration and Castor integrated branch stent techniques in treating type B aortic dissections with inadequate proximal landing zones

“…However, it still requires high-risk, highly invasive open chest surgery. Chimney stent techniques and in-situ fenestration techniques are also frequently used for LSA reconstruction; however, both methods require temporary coverage of the arch branches, which increases the risk of stroke [ 16 ]. Furthermore, chimney stent techniques have a higher incidence of late endoleaks due to the formation of grooves between parallel stents and the main stent [ 17 ].…”