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. 2018 May;7(3):380-388.
doi: 10.21037/acs.2018.04.02.

Endovascular total arch replacement techniques and early results

Vladimir Makaloski  1 , Nikolaos Tsilimparis  1 , Fiona Rohlffs  1 , Franziska Heidemann  1 , Eike Sebastian Debus  1 , Tilo Kölbel  1
Affiliations

Endovascular total arch replacement techniques and early results

Vladimir Makaloski et al. Ann Cardiothorac Surg. 2018 May.

Abstract

During the last 20 years, a clear shift has been observed towards thoracic endovascular aortic repair for different aortic pathologies. However, total endovascular repair of the aortic arch remains technically demanding. Simultaneous perfusion of all supra-aortic arteries without longer cerebral ischemia time, whilst trying to avoid cerebral embolization, labels endovascular aortic arch repair with highest level of technical difficulty and surgical expertise. The aim of this article is to present an overview of the current technical options for endovascular aortic arch repair and their early results. Currently, early results are reported from four endovascular arch replacement techniques: hybrid repair, total endovascular approach, chimney grafts and in-situ fenestration. The early results of these different arch replacement techniques are promising, especially the total arch replacement with custom-made fenestrated or branched stent-grafts. Long-term results are unknown, and larger series results and comparative studies are needed to determine safety and efficacy.

Keywords: Endovascular; arch replacement; early results.

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Conflict of interest statement

Conflicts of Interest: Tilo Kölbel acts as a proctor for, has intellectual property with Cook Medical and receives travel and research grants from Cook Medical. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Postoperative 3D-reconstruction after total aortic arch debranching with ascending-brachiocephalic trunk bypass and transposition of the LCCA and LSA followed by TEVAR in landing zone 0. LCCA, left common carotid artery; TEVAR, thoracic endovascular aortic repair; LSA, left subclavian artery.
Figure 2
Figure 2
Double inner-branch Zenith arch endograft. (A) Intraoperative angiography of an aortic arch aneurysm after open ascending repair with undeployed double-branched stent-graft in the arch; (B,C) double inner-branch Zenith Arch Endograft; (D) completion angiography with bilateral carotid interposition graft and bilateral carotid-subclavian bypass.
Figure 3
Figure 3
Chimney technique for aortic arch. (A) 3D-reconstruction of preoperative CT-angiography; (B) intraoperative angiography with undeployed thoracic stent-graft in the arch and covered stent in the LCCA; (C) balloon-molding in kissing-balloon technique (black arrows) of both chimney graft and thoracic stent-graft; (D) completion angiography after TEVAR, chimney graft in the LCCA and left-sided carotid-subclavian bypass, without plug in the LSA; (E) 3D-reconstruction of postoperative CT-angiography after TEVAR, chimney graft in the LCCA, vascular plug in the LSA and left-sided carotid-subclavian bypass. LCCA, left common carotid artery; TEVAR, thoracic endovascular aortic repair; LSA, left subclavian artery.
Figure 4
Figure 4
In-situ fenestration for aortic arch vessels. (A) Intraoperative fluoroscopy with in-situ fenestration of the thoracic stent-graft; (B) dilation of the fenestration with non-compliant balloon; (C) completion angiography; (D) 3D-reconstruction of postoperative CT-angiography after TEVAR with in-situ fenestration and stenting of the LSA. TEVAR, thoracic endovascular aortic repair; LSA, left subclavian artery.
See this image and copyright information in PMC

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