Abstract
The current minimally invasive endovascular therapy of the descending thoracic aorta makes treatment of the aortic arch appear attractive in order to minimize the trauma of the surgical approach using a heart-lung machine with all its problems of cardiac arrest and hypothermia. Through proximalization of landing zone, complications such as endoleaks, migration and stent collapse can be minimized. ...
Abstract
The current minimally invasive endovascular therapy of the descending thoracic aorta makes treatment of the aortic arch appear attractive in order to minimize the trauma of the surgical approach using a heart-lung machine with all its problems of cardiac arrest and hypothermia. Through proximalization of landing zone, complications such as endoleaks, migration and stent collapse can be minimized. Technical possibilities are scallops at the proximal end of the prosthesis, fenestration and branches, which each have their own special application depending on the pathology and morphology of the aorta. Scallops are used for pathologies of the small curvature, they are technically easier to implant and contribute longitudinal stabilization of the prosthesis. Fenestrations are technically challenging when deployed on the supra-aortic vessels and need to be extended with covered stents. Repeated manipulations carry the risk of embolization. Protheses with branches require great experience and a sophisticated prosthesis design, but placement is usually easier. Using different case studies, indications and applications are described and shown in the figures in order to achieve a basic understanding for future developments.
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