Various Endoluminal Approaches Available for Treating Pathologies of the Aortic Arch
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REVIEW
Various Endoluminal Approaches Available for Treating Pathologies of the Aortic Arch Muzaffar A. Anwar1
•
Mohammad Hamady1,2
Received: 1 January 2020 / Accepted: 9 June 2020 The Author(s) 2020
Abstract Open surgical repair of the aortic arch for degenerative aortic disease in an unfit patient is associated with significant morbidity and mortality. Endoluminal techniques have advanced over the last decade. Contemporary endovascular options including a hybrid approach (supra-aortic debranching and aortic stent graft), inner branched endograft, chimney stents, and scallop or fenestrated endografts are being used frequently as an alternative to open surgical arch repair. Understanding of the available endoluminal technology along with careful planning and effective teamwork is required to minimise complications associated with the endoluminal techniques, particularly neurological ones. Custom made techniques are superior to chimney or parallel technology in terms of their complications and durability. Integration of the protective devices such as embolic protection filters into stent design may reduce the risk of poor neurological sequelae. Long-term data are needed to assess the durability of these devices. Keywords Aortic arch aneurysm Total aortic arch replacement Endovascular aortic arch repair Chimney Scallop Branch stent graft
Introduction Over the last decade, significant progress has been made in the treatment modalities for the aortic arch diseases. Open surgery is still considered the gold standard in young and fit patients as well as in patients with genetic aortic syndrome. Open aortic arch repair requires cardiopulmonary bypass, deep hypothermal circulatory arrest and antegrade or retrograde cerebral perfusion. Cardiopulmonary comorbidities frequently exist in patients with degenerative aortic disease which increase the overall mortality and morbidity with the open repair. Comparable perioperative mortality and stroke rates have been reported between the endovascular arch repair and open arch repair, despite the older age and a higher comorbid profile of patients in the endovascular group [1]. Elective and emergency open repair of arch pathology carries mortality risk of 9% and 37%, respectively [2]. This review focuses on contemporary endovascular options for the treatment of aortic arch pathologies which include hybrid approach (supra-aortic debranching and stent graft), inner branched endograft, chimney stents, and scallop or fenestrated endografts.
& Mohammad Hamady [email protected] 1
Department of Surgery and Cancer, Imperial CollegeLondon, London, England
2
St Mary’s Hospital, Praed Street, London W2 1NY, England
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M. A. Anwar, M. Hamady: Various Endoluminal Approaches Available for Treating Pathologies… Fact Sheet: Key points to remember while planning endovascular aortic arch cases 1
Proximal landing zone should be at least 20 mm (measured on the inner curvature of aorta) and the aortic diameter \ 38 mm
2
Arch angulation [ 60* and absence of thrombus in
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