title: Techniques for aortic arch endovascular repair.
abstract: 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.
authors.affiliation: Skane University Hospital, Malmö, Sweden - timothyresch@gmail.com.
authors.forename: Kiattisak
authors.initials: K
authors.lastname: Hongku
authors.forename: Nuno
authors.initials: N
authors.lastname: Dias
authors.forename: Bjorn
authors.initials: B
authors.lastname: Sonesson
authors.forename: Timothy
authors.initials: T
authors.lastname: Resch
mesh_terms: D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D018579:Patient Selection; D012307:Risk Factors; D015607:Stents