title: Branched and fenestrated options to treat aortic arch aneurysms.
abstract: Conventional surgical repair of aortic arch aneurysms using cardiopulmonary bypass and hypothermic circulatory arrest remains the gold standard, however it is associated with a substantial mortality and morbidity rate, especially in the elderly. Hybrid techniques avoid aortic cross-clamping and circulatory arrest, but are of limited use and are only applicable to selected patients. The development of new devices to treat aortic arch aneurysms endovascularly has the potential to offer a treatment modality to patients unfit for an open repair. We present the challenges specific to endovascular arch repair based on our experience and the literature available from the first experience in 1999 to the third generation graft currently commonly used. Following an initial learning curve associated with the use of the third generation arch branch device, along with careful patient selection and operator experience, early results are promising. Technical success was achieved in all cases, there was no early mortality and strokes were noted in 11%. As with branched and fenestrated technology for thoracoabdominal aneurysm repair, the use of total endovascular repair for arch pathology will require an evolution in endovascular practice and device design. However, at present, the early use of the latest generation device offers a novel approach to patients who previously had no surgical options.
authors.affiliation: Aortic Center, Cardiology Hospital, Lille University Hospitals, Lille, France - haulon@hotmail.com.
authors.forename: Blandine
authors.initials: B
authors.lastname: Maurel
authors.forename: Tara M
authors.initials: TM
authors.lastname: Mastracci
authors.forename: Rafaelle
authors.initials: R
authors.lastname: Spear
authors.forename: Adrien
authors.initials: A
authors.lastname: Hertault
authors.forename: Richard
authors.initials: R
authors.lastname: Azzaoui
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sobocinski
authors.forename: Stephan
authors.initials: S
authors.lastname: Haulon
mesh_terms: D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D002983:Clinical Competence; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D059032:Learning Curve; D011183:Postoperative Complications / Q000209:etiology; D011474:Prosthesis Design; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome