Contemporary Management of Aortic Arch Aneurysm

The management of the aortic arch aneurysm is becoming increasingly complex and multidisciplinary. It has evolved since the first successful repair by DeBakey et al in 1957. After these initial repairs, the improvement in open surgical techniques, cardiopulmonary bypass, anesthesia, and perioperative care were the primary drivers of the decrease in morbidity and mortality associated with repair. The development of endovascular technology has spurred another revolution in the management of aortic arch aneurysms. In this review, we present a current appraisal and description of open surgical, hybrid, and endovascular techniques based on the literature. These techniques are varied and have different advantages and disadvantages, depending on patient anatomy and perioperative surgical risk. We provide an overview of the attributes of each technique and how they may be applied to individual cases. While each technique could not be discussed in detail in this report, it is clear that institutions must be able to proficiently offer the full spectrum of open, hybrid, and endovascular surgical techniques to treat this diverse condition. For low and intermediate risk patients, open surgery remains the gold standard. However, just as improvements in technique, monitoring and perioperative care led to progress in open repair, similar advancements in endograft technology, anatomical customization, and embolic protection will expand the use of endovascular repair. As the management of the condition becomes increasingly nuanced and multidisciplinary, centers must be equipped to offer a variety of techniques with high fidelity and adaptability to each unique patient.