The Use of Branched Endografts for the Aortic Arch in the Endovascular Era

Rami O. Tadros, Scott R. Safir, Peter L. Faries, Daniel K. Han, Rajiv K. Chander, Cherrie Abraham, Michael L. Marin, Allan S. Stewart

Research output: Contribution to journalArticle

Abstract

The endovascular realm has steadily increased its footing in the treatment of the aorta and all of its territories since the foundational case in 1990 by Parodi. The aortic arch, however, continues to be one of the last bastions for treatment via open surgery, which remains the gold standard. Significant comorbidity and prior cardiac surgery prevent open surgery from being the only preferred option, allowing novel endovascular procedures to be considered. Since 1999, more advanced endovascular systems have been created by companies such as Cook Medical, Bolton Medical, Medtronic, Endospan, Gore Medical, and, recently, Kawasumi. The unique shape and angulation of the aortic arch often require the use of custom-made grafts, though arch reconstruction may also include in situ or back-table physician alterations to off-the-shelf devices. The goal of branched endografts is to exclude the aneurysm, while maintaining flow to supra-aortic trunk vessels. Technical success and device durability are limited by the physical constraints of the aortic arch, though greater experience may yield better patient outcomes. Typically, the initial stent-graft (SG) is introduced and deployed into the arch first. Bridging SG are then inserted via axillary or carotid access. Most often, the bridging SG extends from the innominate branch to the distal innominate, and from the left carotid branch to the left common carotid. The major concern is that manipulation of catheters and wires, both within the carotid arteries and aortic arch, create the potential for emboli leading to stroke and paraplegia. The development of endovascular-only techniques for aortic arch pathology will only increase with the aging population of the United States and associated accumulation of comorbidities, making open surgery too grave of a risk.

Original languageEnglish (US)
Pages (from-to)236-242
Number of pages7
JournalSurgical technology international
Volume30
StatePublished - Jul 25 2017

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Thoracic Aorta
Stents
Transplants
Endovascular Procedures
Comorbidity
Equipment and Supplies
Paraplegia
Embolism
Carotid Arteries
Thoracic Surgery
Aneurysm
Aorta
Catheters
Stroke
Pathology
Physicians
Therapeutics
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Tadros, R. O., Safir, S. R., Faries, P. L., Han, D. K., Chander, R. K., Abraham, C., ... Stewart, A. S. (2017). The Use of Branched Endografts for the Aortic Arch in the Endovascular Era. Surgical technology international, 30, 236-242.

The Use of Branched Endografts for the Aortic Arch in the Endovascular Era. / Tadros, Rami O.; Safir, Scott R.; Faries, Peter L.; Han, Daniel K.; Chander, Rajiv K.; Abraham, Cherrie; Marin, Michael L.; Stewart, Allan S.

In: Surgical technology international, Vol. 30, 25.07.2017, p. 236-242.

Research output: Contribution to journalArticle

Tadros, RO, Safir, SR, Faries, PL, Han, DK, Chander, RK, Abraham, C, Marin, ML & Stewart, AS 2017, 'The Use of Branched Endografts for the Aortic Arch in the Endovascular Era', Surgical technology international, vol. 30, pp. 236-242.
Tadros RO, Safir SR, Faries PL, Han DK, Chander RK, Abraham C et al. The Use of Branched Endografts for the Aortic Arch in the Endovascular Era. Surgical technology international. 2017 Jul 25;30:236-242.
Tadros, Rami O. ; Safir, Scott R. ; Faries, Peter L. ; Han, Daniel K. ; Chander, Rajiv K. ; Abraham, Cherrie ; Marin, Michael L. ; Stewart, Allan S. / The Use of Branched Endografts for the Aortic Arch in the Endovascular Era. In: Surgical technology international. 2017 ; Vol. 30. pp. 236-242.
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