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<p>The individual heterogeneity of the aortic arch morphology and pathologies places high demands on endovascular treatment strategies. Over the past decades surgical debranching strategies in combination with thoracic endovascular aortic repair (TEVAR) and complex endovascular arch repair have emerged as viable alternatives to open aortic arch replacement. Recent systematic reviews demonstrated high technical success rates for complex endovascular procedures coupled with a&#xa0;relatively low perioperative risk of mortality in a&#xa0;multimorbid patient cohort. Despite these positive outcomes, the risk of stroke and reinterventions range from 5–10% and therefore remain a&#xa0;significant challenge. Elective cases can be successfully treated with customized prosthetic devices, whereas surgeon-modified or in situ fenestrated prostheses offer alternatives for urgent interventions. Parallel grafts can be used as a&#xa0;bail-out option but carry an increased risk of endoleaks and reinterventions. Technical advances, such as multibranched or fenestrated stent grafts, have expanded the treatment possibilities; however, due to significantly shorter proximal landing zones women have fewer endovascular treatment options compared to men. The aim of developing a&#xa0;standardized off-the-shelf endoprosthesis for the aortic arch has gained in importance. Future research is focused on further refining standardized designs while maintaining safety and efficacy, further supporting the growing trend towards more liberal indications.</p>

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Endovaskuläre Versorgung des Aortenbogens – Wo stehen wir heute?

  • 期刊论文

  • 发表日期：

    2025年1月14日

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  • David Khangholi,
  • N. Konstantinou,
  • J. Stana,
  • M. Pichlmaier,
  • Nikolaos Tsilimparis

摘要

The individual heterogeneity of the aortic arch morphology and pathologies places high demands on endovascular treatment strategies. Over the past decades surgical debranching strategies in combination with thoracic endovascular aortic repair (TEVAR) and complex endovascular arch repair have emerged as viable alternatives to open aortic arch replacement. Recent systematic reviews demonstrated high technical success rates for complex endovascular procedures coupled with a relatively low perioperative risk of mortality in a multimorbid patient cohort. Despite these positive outcomes, the risk of stroke and reinterventions range from 5–10% and therefore remain a significant challenge. Elective cases can be successfully treated with customized prosthetic devices, whereas surgeon-modified or in situ fenestrated prostheses offer alternatives for urgent interventions. Parallel grafts can be used as a bail-out option but carry an increased risk of endoleaks and reinterventions. Technical advances, such as multibranched or fenestrated stent grafts, have expanded the treatment possibilities; however, due to significantly shorter proximal landing zones women have fewer endovascular treatment options compared to men. The aim of developing a standardized off-the-shelf endoprosthesis for the aortic arch has gained in importance. Future research is focused on further refining standardized designs while maintaining safety and efficacy, further supporting the growing trend towards more liberal indications.