Open, Hybrid and Endovascular Management of Aortic Arch Aneurysms: Recent Updates and Future Directions

Once considered a surgical frontier fraught with risk, aortic arch aneurysms now represent a domain of evolving innovation. Despite their rarity, they pose severe risks of dissection, rupture, and mortality if not adequately managed. Primarily caused by prior aortic dissections, atherosclerosis, or connective tissue disorders, these aneurysms are often found incidentally on CTA or MRA imaging. Medical management focuses on reducing aortic wall stress through blood pressure control, risk factor modification, and regular imaging to monitor growth. Surgical intervention is typically indicated when the aneurysm diameter exceeds 5.5 cm, exhibits rapid growth, or causes symptoms such as compression or dissection. Open repair remains the gold standard for treatment due to its superior long-term outcomes, though hybrid and endovascular approaches are favored for high-risk patients due to reduced perioperative morbidity. Innovations in hybrid techniques and endovascular devices, alongside advancements in cerebral perfusion strategies, are shaping the future of personalized and minimally invasive approaches to aortic arch repair. This comprehensive review delves into the current management strategies for these aneurysms.