title: Current and future perspectives in the repair of aneurysms involving the aortic arch.
abstract: The repair of aneurysms involving the aortic arch is technically and physiologically demanding. Historically, these aneurysms have been treated using open surgical techniques that require cardiopulmonary bypass and deep hypothermic circulatory arrest. Many patients have been deemed "untreatable" and among those selected for surgery there are reported risks of death in 2% to 16.5% and stroke rates ranging from 2% to 18%. "Hybrid arch repair" combines one of a number of open surgical procedures (to secure a proximal landing zone for an endograft) with subsequent or immediate placement of an endograft in the arch and descending aorta. Although this concept is described as "minimally invasive" because it avoids aortic cross-clamping and hypothermic circulatory arrest, the morbidity and mortality rates remain considerable (mortality 0% to 15%, stroke 0% to 11%). Ongoing development of endograft technology has enabled total endovascular repair of complex aortic aneurysms involving the visceral segment, using fenestrated and branched endografts. Encouraging early results in this anatomy have inspired extension of the concept to include the aortic arch and great vessels. These strategies can be considered in patients generally at high-risk for the conventional procedures. However, the endeavour is at an early stage of its development and the arch poses unique challenges including the potential for stroke, angulation of the arch and the great vessel ostia to the arch, extremely high volume flow, three-dimensional pulsation and rotation with the cardiac cycle and the proximity of the aortic valve and coronary arteries.
authors: Vascular and Cardiac Surgery, Aortic Centre, Hôpital Cardiologique, CHRU de Lille, France - stephan.haulon@chru-lille.fr.
authors: B
authors: B
authors: Maurel
authors: J
authors: J
authors: Sobocinski
authors: R
authors: R
authors: Spear
authors: R
authors: R
authors: Azzaoui
authors: M
authors: M
authors: Koussa
authors: A
authors: A
authors: Prat
authors: M R
authors: MR
authors: Tyrrell
authors: A
authors: A
authors: Hertault
authors: S
authors: S
authors: Haulon
mesh_terms: D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology; D011474:Prosthesis Design; D012307:Risk Factors; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome