[Treatment of aneurismal lesions of the aortic arch: towards a new model of collaboration between physicians and technologists].

Until quite recently, aneurismal or dissecting lesions of the aortic arch were untreatable, leaving patients exposed to a risk of fatal rupture. Indeed, aortic arch surgery concentrates most of the difficulties encountered during arterial repair. Access to the lesion takes one or more invasive thoracic incisions during open repair, or complex and embologenic navigation during endovascular repair. The proximity of the heart means that the affected segment can only be isolated by means of cardiac or circulatory arrest, or bypass, while flow interruption through the supra-aortic trunks carries a risk of cerebral ischemia within a matter of minutes. In addition, the geometry and dynamics of the aortic arch subject synthetic devices to major stresses both during and after repair. Various technologies have been harnessed in an attempt to increase the proportion of patients amenable to therapy, such as hemodynamic protection by cardiopulmonary or extra-anatomic bypass, tissue preservation technologies, and endovascular approaches. Progress remains slow, however, owing to the lack of a suitable medico-economic model for this relatively infrequent disorder. These lesions therefore represent an excellent model for developing new collaborative approaches between medical and technological research.