Endovascular Arch Repair: Endograft Design Options and Worldwide Results

Area of Science:

• Vascular Surgery
• Medical Device Technology
• Cardiovascular Research

Background:

• Aortic arch pathologies pose significant treatment challenges.
• Traditional open repair methods carry high risks for complex aortic arch diseases.

Purpose of the Study:

• To review procedural and technical advancements in branched and fenestrated thoracic endovascular aortic repair (B-/F-TEVAR).
• To evaluate clinical outcomes, focusing on stroke and mortality associated with B-/F-TEVAR for aortic arch pathologies.

Main Methods:

• A narrative literature review was conducted.
• Assessed evolution of B-/F-TEVAR devices, technical success, perioperative and long-term outcomes, mortality, and stroke rates.

Main Results:

• B-/F-TEVAR demonstrates high technical success (84%-100%).
• 30-day mortality rates range from 0%-25%, with stroke rates from 3%-36%.
• Fenestrated repairs suit lesser curvatures with lower mortality; branched repairs offer adaptability for complex anatomies but may have higher stroke risks.

Conclusions:

• B-/F-TEVAR is a feasible option for selected high-risk patients with aortic arch pathology.
• Stroke is a significant complication, and reintervention rates underscore the need for improved long-term durability.