Endovascular surgery for thoracic aortic pathologies involving the aortic arch

Area of Science:

• Cardiovascular Surgery
• Vascular Endovascular Therapy
• Aortic Arch Reconstruction

Background:

• Aortic arch pathologies present significant clinical challenges with high mortality rates.
• Traditional open surgery for these conditions carries substantial risks, especially for critically ill patients.
• Endovascular techniques are emerging as a promising alternative for treating aortic arch pathologies.

Purpose of the Study:

• To evaluate the feasibility, efficacy, and safety of endovascular treatment for aortic arch pathologies.
• To present initial clinical experience with endovascular aortic arch repair.
• To assess methods for maintaining cerebral blood flow during aortic arch interventions.

Main Methods:

• Thoracic endovascular aortic repair (TEVAR) was performed on 62 patients with aortic arch lesions.
• Proximal stent-graft landing zones were in Ishimaru zones 0-1, requiring cerebral flow maintenance.
• Supra-aortic branches were reconstructed using in situ fenestration or the chimney technique.

Main Results:

• Successful reconstruction of all supra-aortic branches was achieved in 51 cases.
• Early mortality was 6.45%, with no reported neurological complications.
• Post-operative imaging confirmed stent patency and absence of endoleaks or migration at a mean follow-up of 3.51 months.

Conclusions:

• Endovascular techniques provide an effective, feasible, and safe method for aortic arch reconstruction.
• The study demonstrates successful reconstruction of supra-aortic branches using endovascular approaches.
• This approach offers a repeatable solution for managing complex aortic arch diseases.