Angioplasty and Stenting of the Arch Branches

This chapter provides an overview of arterial disorders affecting the aortic arch, supra-aortic branches, and upper extremities, which are less common compared to lower extremity disorders. The chapter discusses various pathologies such as aortic arch aneurysm, atherosclerosis, and acute aortic syndrome (including dissection, penetrating aortic ulcer (PAU), and intramural hematoma). The vascular anatomy of the aortic arch is described, highlighting the normal arch development and the differentiation of the aortic arches and the associated aortic arch anomalies. This chapter discusses the endovascular approach for the treatment of the aforementioned various vascular conditions. It highlights the use of endovascular techniques in patients who are not suitable for open surgery or have catheter-induced arterial injuries. The chapter further delves into the use of angioplasty and stenting in the treatment of arterial stenosis or occlusion. Stent-grafting, both for subclavian artery aneurysms and traumatic injuries to the axillary and subclavian arteries, is also explored with the challenges associated. The chapter concludes with a discussion on advanced devices used in cases involving extensive aortic disease and branch vessel involvement. Debranching procedures and the use of fenestrated and branched endografts are presented as approaches to manage complex cases. The chapter highlights investigational devices for treating aortic arch pathology and emphasizes the need for individualized device selection based on specific clinical indications.