“Loss of landing zone”—Stabilizing endovascular treatment solutions in the aortic arch after thoracic endovascular aortic repair

Addressing proximal complications that arise after endovascular aortic repair for type B aortic dissection, like Endoleak Ia, "bird-beaking" of the TEVAR stent, retrograde type A dissection or postdissection aneurysm, presents considerable complexities. We present a novel and safe method for open arch repair that can ensure a secure and efficient approach for TEVAR complications. The key element of the operative technique is approximating the grafted stent portion to the aortic wall and to the arch prosthesis. The technique has successfully been implemented in 11 patients, who received secondary open arch repair from 2019-2022 after TEVAR for type B dissection. Our objective is not only to introduce this reliable concept but also to provide a comprehensive demonstration of its advantages and pitfalls compared to currently employed open treatment methods as well as discussing patient´s outcomes after secondary open arch repair.