A less invasive approach to completely repair the aortic arch

Surgical replacement of the aortic arch is an established procedure that requires cardiopulmonary bypass and deep hypothermic circulatory arrest. However, this approach is associated with major perioperative risks. The significant risks associated with conventional open repair of the thoracic aorta are the main argument for less invasive strategies.

We present a less invasive surgical and endovascular approach that allows total exclusion of the aortic arch without the need for extracorporeal circulation, deep hypothermia, and circulatory arrest.

All procedures were successful, and the patients recovered without neurologic, cardiac, or bleeding complications. Arteriography confirmed proper position of the stent graft and complete exclusion of the lesion at the end of the procedure. One patient had an endoleak type I and underwent successful additional retrograde stent-graft placement over the proximal landing zone 3 weeks after the initial procedure. Clinical follow-up (between 8 and 18 months) was fully uncomplicated in all patients. Computed tomographic scan at 6 months demonstrated complete exclusion of the arch lesion in all cases and did not reveal any endoleaks.

Assuming that technical refinements may improve all steps of the endovascular intervention, this combined approach may turn out to be the preferred therapeutic modality to repair aortic arch lesions in patients with multiple comorbidities who otherwise would not be candidates for a conventional operative repair. However, long-term observation is necessary to confirm the stability of this type of repair.