Total aortic arch repair between endo and hybrid-the Nexus single-branched endograft.

Abstract

Minimally invasive zone 0 arch procedures have experienced a great evolution from the total zone 0 debranching techniques towards the total endovascular aortic arch procedures in the last decade. This evolution followed the aim of improved perioperative outcomes for patients with substantial comorbidities, who are not candidates for open aortic arch repair. Nowadays, branched endografts are the main endovascular alternative to the frozen elephant trunk technique. In the case of anatomical suitability, branched endovascular repair of the aortic arch offers an excellent treatment option for patients with severe risk profiles for open surgery [1]. The repair is predominantly based on the custom-made inner branch platforms, with 2 or 3 tunnels located in the main graft, which allow for a safe overlap with the bridging stent grafts to the supra-aortic vessels [2]. From the technical point of view, the Nexus single-branched endograft is different. It is bimodular and consists of a branched arch and an anatomically preshaped ascending aorta module. The branch to the brachiocephalic trunk (BCT) is located at the proximal end of the arch module and allows for precise deployment of the BCT branch from the bifurcation to the BCT origin prior to the complete deployment of the aortic arch and descending aorta portion. The implantation is accomplished by the deployment of the ascending module, which lands distally with its locking latches into the docking sleeve of the arch module.