Key result
Novel off-the-shelf endograft designs may achieve anatomical suitability in up to ~97% of arch cases.
Why the study?
To synthesize evidence on anatomical considerations of supra-aortic trunks and their impact on the feasibility and design of off-the-shelf and custom-made endografts in endovascular aortic arch repair.
While anatomical variability of supra-aortic trunks limits the universal application of off-the-shelf endografts for aortic arch repair, strategic standardized designs may accommodate the vast majority of patients.
Answers are grounded in this paper and cite their sources.
Supra-aortic trunk variability limits off-the-shelf endograft applicability; leaves open whether strategic designs can achieve broad clinical use.
OBJECTIVE: To review and synthesize current evidence on the anatomical considerations of supra- aortic trunks (SATs) and their impact on the feasibility and design of off- the- shelf (OTS) and custom- made endografts in endovascular aortic arch repair. METHODS: A narrative review was conducted using PubMed and Scopus databases, focusing on studies evaluating SAT morphology, spatial orientation, and device applicability. Studies addressing clock- face orientation, vessel diameters, inter- branch distances, and anatomical suitability for branched or fenestrated devices were included. RESULTS: Anatomical studies revealed significant variation in SAT configuration, particularly inter- vessel spacing and clock- face orientation. While some consistency in takeoff angles exists, only a subset of patients met the criteria for current OTS devices. Proposed configurations in planning studies—particularly those involving a large left common carotid artery scallop and left subclavian artery fenestration or inner branches—may cover up to 85–97% of cases. Still, challenges remain due to arch angulation, large ascending diameters, and rotational misalignment in tortuous anatomy. Custom- made devices provide high anatomical conformity but are impractical in urgent settings due to production delays. CONCLUSIONS: Anatomical variability remains a key limitation in the broader application of OTS devices for total endovascular aortic arch repair. However, strategic graft design may allow a limited set of configurations to accommodate most patient anatomies. Standardized preoperative measurements and continued refinement of device designs are essential to improving procedural success and expanding clinical applicability.
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Fernandes et al. (2025) conducted a review in Aortic arch pathology. Off-the-shelf and custom-made endografts was evaluated. Anatomical variability of supra-aortic trunks remains a key limitation for off-the-shelf endografts, although strategic graft designs and proposed configurations may cover up to 85-97% of cases.
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