Upcoming Technology for Aortic Arch Aneurysms

D espite major advances in complex aortic arch reconstruction, these challenging procedures are still fraught with significant problems such as bleeding; cardiac, pulmonary, and renal complications; and stroke. Conventional surgical repair of aortic arch pathology is an invasive procedure often necessitating cardiopulmonary bypass and deep hypothermic circulatory arrest. Although there has been progress made in surgical technique, anesthesia, and intensive care management, total arch replacement still carries a perioperative mortality or stroke rate approaching 10% to 15%, even in major referral centers.1 The operative risk is even more elevated in elderly patients, patients requiring emergency repair, and in those with major preexisting comorbidities. As a result, many patients are deemed unsuitable for open repair. Recently, repair in these patients with aortic arch aneurysms has been accomplished using both hybrid (endovascular combined with open techniques)2 and “near-total” endovascular techniques.3,4