Endovascular Treatment of Aortic Arch Aneurysms

Abstract

INTRODUCTIONː Open surgical repair remains the standard treatment option for aortic arch aneurysms. Although effective, this approach requires cardiopulmonary bypass and deep hypothermic circulatory arrest, and is therefore unfit for high surgical risk patients. Hybrid repairs have been developed as alternative treatment options for such scenarios, but, like the former, high-risk patients are frequently precluded from such interventions. Totally endovascular treatment options have later been introduced as less invasive treatment approaches for such high-risk patients, and their use has seen a significant increase in recent years. In this article, we aim to review the current status of the different endovascular alternatives for aortic arch aneurysm repair.

EVIDENCE ACQUISITIONː A thorough literature search was performed through a comprehensive electronic search of PubMed/Medline databases. Forty-two articles were included, according to their scientific relevance and the authors' preferences. EVIDENCE SYNTHESISː Endovascular treatment alternatives for aortic arch aneurysm repair include custom-made branched aortic arch endografts, fenestrated aortic arch endografts, physician-modified devices and parallel grafts. Endovascular stent grafting is deployed under a minimally invasive procedure and without interrupting blood flow. Overall, the high technical success rates and low aortic-related deaths during follow-up are encouraging, though more data on long term effectiveness are needed. The risk of stroke, reintervention rates, lack of widespread availability and lengthy manufacturing time are the most significant drawbacks of the currently available endovascular treatment approaches. CONCLUSIONSː The development of new endovascular techniques have expanded the treatment armamentarium for aortic arch aneurysms, enabling treatment of otherwise inoperable high-risk patients.