Total aortic endovascular repair

Endovascular repair has an established role in aortic treatment and has with evolving technologies expanded its applicability to the whole aorta. Whereas open repair is still the standard treatment for aortic arch and ascending aortic pathology, in high-risk patients, endovascular treatment has gained an increasing role. Endovascular options range from hybrid procedures to total endovascular repair using chimney grafts, branched and fenestrated stent grafts. Thoracic endovascular repair (TEVAR) for descending aortic pathologies including aneurysms, traumatic aortic transection, and complicated type B aortic dissection (TBAD) have also been firmly established and in many cases shown superior to open alternatives. For uncomplicated type B aortic dissection, TEVAR is controversial weighing the benefits of the long-term outcomes with increased short-term morbidity and mortality. Endovascular thoracoabdominal aortic aneurysm repair with fenestrated and branched stent grafts have also established its role with excellent short-term results and promising long-term durability. Staging of extensive repairs is widely adopted to prevent spinal cord ischemia. Off-the-shelf (OTS) devices have a complimentary role in emergency situations where custom-made device (CMD) are not available. Chimney and parallel graft techniques also still have a place in emergency situations. Fenestrated stent graft is a solid treatment for pararenal aneurysms with the trend toward more complex repair that aims for durability without compromising the operative outcomes. OTS fenestrated repair for juxtarenal aneurysms have shown its feasibility in the short-term but long-term results are yet to be published. Techniques for infrarenal aneurysm repair have reached a plateau. New devices have been developed to overcome the anatomical limitations of current stent grafts, especially for unfavorable neck anatomy. New polymer-based endovascular sealing (EVAS) technique has shown its feasibility and promising early outcomes, however long-term evidence is needed to define its role in the treatment armamentarium. Lastly, hypogastric artery preservation is now more feasible when iliac-branched devices have shown a good long-term patency and some new devices are available in clinical trial. This article gives an overview of available options and the results of endovascular solutions for the entire aorta from the ascending aorta to the iliac artery.