Endovascular Arch Repair: Endograft Design Options and Worldwide Results.

OBJECTIVES

This review evaluates procedural and technical advancements in branched and fenestrated thoracic endovascular aortic repair (B-/F-TEVAR) for aortic arch pathologies, with the main focus on the clinical outcomes, including stroke and mortality.

METHODS

A narrative review of the literature was conducted to assess the evolution of B-/F-TEVAR devices, including branched and fenestrated designs. Key factors such as technical success, perioperative outcomes, and long-term performance were examined across various patient cohorts, with the focus on mortality and stroke.

RESULTS

B-/F-TEVAR achieves high technical success rates (84%-100%), with 30-day mortality and stroke rates typically ranging from 0% to 25% and 3% to 36%, respectively. Fenestrated repairs are particularly suited for pathologies involving the lesser aortic curvature, offering reduced mortality (as low as 2% in some studies), while branched repairs provide greater adaptability for complex anatomies, albeit with higher stroke rates in certain cohorts.

CONCLUSIONS

B-/F-TEVAR has emerged as a feasible treatment option for selected high-risk patients with aortic arch pathology, achieving high technical success. Although outcomes may improve with growing experience, stroke remains a significant complication, and reintervention rates highlight the need for long-term durability.