Hybrid and Total Endovascular Solutions for Aortic Arch Disease: Contemporary Surgical Strategies

Aortic arch diseases represent one of the most complex domains in cardiovascular surgery due to the need for cerebral protection, anatomical precision, and durable reconstruction. Their management requires highly individualized strategies that balance cerebral protection, systemic organ perfusion, anatomical complexity, and long-term durability. Over recent decades, antegrade cerebral perfusion has significantly reduced neurological morbidity. In parallel, vascular prostheses have progressed from conventional Dacron grafts to hybrid stent graft systems simplifying arch reconstruction and expanded treatment options in high-risk cohorts. Total endovascular arch repair using branched or fenestrated devices has emerged for selected high-risk patients; however, current data remain limited, with early stroke rates of approximately 5-8% and restricted long-term durability evidence. From both clinical and economic perspectives, open and hybrid approaches remain central to durable arch management.