Endovascular hybrid operations of the aortic arch - quo vadis?

摘要

abstract_textpEndovascular hybrid operations of the aortic arch are now an integral part of the spectrum of surgical measures for treatment of pathologies of the aortic arch. They greatly widen the therapeutic window for endovascular treatment of thoracic aorta lesions (TEVAR) in the region of the aortic arch. The experiences of international centers show that acceptable results can be achieved with these methods. Supra-aortic debranching is also an attractive solution for patients with limited cardiopulmonary reserves who are not suitable for open aortic arch reconstruction. Furthermore, it allows an extension of the indications for TEVAR to establish a sufficient proximal landing zone, because the vast majority of pathologies are localized in close anatomical neighborhood to the head and neck vessels. The present technology of commercial endoprostheses was not designed for the aortic arch (off-label use), therefore, the special demands of the morphology, physiology and hemodynamics of the aortic arch can only partly be fulfilled. Nevertheless, continuous improvements and innovations in the development of future endoprostheses will lead to a further reduction in invasiveness. Single sidebranch endoprostheses are the first step and allow an extrathoracic debranching for the complete endovascular arch replacement. Endovascular hybrid interventions will also enrich the individualized therapy concept in the region of the aortic arch in the future./p/abstract_text