Endovascular Management of Aortic Arch Disease

Endovascular treatment of the aortic arch is an important challenge in the field of vascular surgery. Currently, open surgical repair of the aortic arch is still the gold standard in patients who are suitable for open surgery. The advantages of endovascular repair with mini-invasive approach are gaining interest in reducing rates of serious adverse events and expanding the indication to high-risk surgical patients. Different endovascular approaches are nowadays suitable to manage aortic arch diseases, and the type of repair depends on the clinical presentation, the lesion localization, the expertise of the surgical team, and the availability of endovascular devices. Elective and recommended options are fenestrated and branched custom-made endografts that are reaching high levels of results and experience in the main aortic centers. Parallel graft and in-situ/physician-modified options are instead considered as bail-out or urgent techniques. This chapter gives an overview on the indications, techniques, and results of the endovascular option for aortic arch diseases and some perspectives for future development in this intriguing and steeply rising field of vascular surgery.