Adjunctive techniques such as vessel transposition and bypass grafting can expand the applicability of minimally invasive thoracic endografting to high-risk patients with complex aortic arch anatomy.
Should not yet change practice for complex arch disease; extends observational data on hybrid TEVAR pending prospective trials.
The endovascular repair of thoracic aortic pathology is on an evolutionary threshold, as advancing technologies and techniques combine to offer the interventionist expanded treatment opportunities. A variety of maneuvers are recommended to address the landing zone limitations to thoracic endografting imposed by the arch vessels: transostial bare stent placement, intentional occlusion of the arch vessel origin, vessel transposition, and bypass grafting. These adjunctive techniques can help us extend the option of a minimally invasive treatment to a greater number of patients with severe thoracic aortic lesions and comorbidities that place them at high risk for standard surgical intervention.
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Criado et al. (2002) studied this question.
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