Endovascular aortic arch repair: a review of current technologies, clinical outcomes, and future directions

Endovascular treatment of the aortic arch (EndoArch) has emerged as an increasingly important therapeutic option for the management of complex aortic arch disease, driven by continuous advances in device technology, imaging, procedural planning, and operator experience. Although conventional open arch replacement remains the reference treatment for many patients, endovascular approaches have considerably expanded therapeutic options for individuals considered at high surgical risk. However, the anatomical complexity of the aortic arch, the need to preserve supra-aortic trunk perfusion, and the risk of neurological complications continue to make these procedures technically demanding. This review provides an updated overview of contemporary EndoArch, with a particular focus on currently available endovascular and hybrid strategies, clinical outcomes, procedure-related complications, and future perspectives. Available evidence demonstrates encouraging technical success and acceptable early and mid-term results in carefully selected patients treated at experienced aortic centers, although most data derive from retrospective observational studies and long-term durability has yet to be established. Careful patient selection, meticulous procedural planning, and a multidisciplinary approach remain fundamental to achieving optimal outcomes. Ongoing technological developments, including improvements in endograft design, procedural standardization, advanced imaging, and the progressive extension of endovascular treatment to more proximal aortic segments, are expected to further broaden the applicability of EndoArch. Continued clinical experience and longer-term follow-up will be essential to better define the role of these techniques in contemporary management of aortic arch disease.