Endovascular Aortic Arch Repair After Aortic Arch De-branching

Abstract

Conventional surgical therapy of aortic arch aneurysms consists of aortic arch replacement requiring cardiopulmonary bypass and deep hypothermic circulatory arrest. This method is associated with significant morbidity and mortality, mainly due to neurologic complications and the sequelae of deep hypothermic circulatory arrest. Thus, it makes sense to work on developing less invasive surgical techniques. Surgical aortic arch de-branching is required before the supra-aortic vessels can be safely covered by an endovascular stent graft. We describe how the supra-aortic vessels can best be revascularized, followed by complete coverage of the aortic arch with endovascular stent grafts. We hereby present our case selection criteria, preoperative work-up, and surgical approach for aortic arch de-branching with supra-aortic revascularization, followed by complete coverage of the aortic arch by endovascular stent grafting. This technique's safeguards and pitfalls are described for a cohort of 26 patients. Endovascular aortic arch repair after aortic arch de-branching has the potential to lower the morbidity and mortality rates in patients with aortic arch diseases.