The Endovascular Treatment of Aortic Arch Pathologies

The endovascular treatment of pathologies of the aortic arch has become established in recent years, not only as a complementary treatment option but also as an alternative to open surgery for selected patients. The prevalence of thoracic aortic aneurysms is approximately 0.16%.

In this narrative review, we present the endovascular treatment options for aortic arch disorders.

The endovascular treatment of aortic arch pathologies has been evaluated to date mainly in uncontrolled, retrospective studies. A prerequisite for endovascular treatment of the aorta is the availability of an adequate landing zone in which the stent graft can be anchored both proximally and distally. Stable, asymptomatic aneurysms can be treated conservatively with frequent follow-up. Endovascular aortic arch procedures have high technical success rates (branched thoracic endovascular aortic repair: 96.3%, fenestrated thoracic endovascular aortic repair: 95.7%), a 30-day mortality of 6.3%, and a 30-day stroke rate of 9.4% (weighted average values). The endoleak rates range from 2.6% to 37.6% (weighted average, 19.6%). Especially for patients with a high surgical risk, this minimally invasive method can be used as an alternative to open surgery in specialized centers. Indications must be determined on a case-by-case basis.

The published studies vary widely in case numbers and patient collectives; randomized controlled trials are lacking, as is a direct comparison with open aortic arch replacement surgery. Improvements in aortic arch prostheses enable improved, more individualized treatment; the risk profile of each patient must be considered by the interdisciplinary aorta team along with the advantages and disadvantages of the various available types of prosthesis.