Patient-Tailored Therapy for Complex Aortic Arch Anatomy: An Evolving Research Field with Custom-Made Solutions

Figures

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  Figure 1. Patient 1’s Computed Tomography Angiography showing a Penetrating Aortic Ulcer (PAU) of the aortic arch (A) and the complete exclusion of the PAU after Thoracic Endovascular Aortic Repair (TEVAR) with reduction in the dimension of the pseudoaneurysm (B).

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  Figure 2. Patient 2’s 3D reconstruction showing the right common carotid–left common carotid and left common carotid–left subclavian artery bypass and the type IA endoleak (blue arrow) (A). In panel (B), the result of the treatment with a custom-made solution with a landing zone in Zone 0 and a single branch for the innominate artery.

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  Figure 3. Patient 3’s Computed Tomography Angiography showing the evolution of the type B dissection with an enormous aneurysm of 75 mm in Zone 3 (A). Three-dimensional reconstruction of the result after the frozen elephant trunk operation (B). After one month, the patient was treated with another TEVAR in the descending aorta.

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  Figure 4. Patient 4’s 3D reconstruction showing the previously positioned TEVAR with left carotid–left subclavian artery bypass, the truncus bovinus, and the type IA endoleak (blue arrow) (A). Intraoperative image of the ascending aorta replacement and the debranching with the division of the left carotid artery from the innominate artery (B). Angiography of the final result after Zone 0 landing of the TEVAR with complete exclusion of the endoleak (C).

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  Figure 5. Patient 5’s Computed Tomography Angiography reconstruction showing the type III endoleak caused by rupture of the TEVAR secondary to infection.

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  Figure 6. Decision-making flowchart for the correct treatment of the patient with complex aortic pathology. The patient is at the core of the decision-making process, where the multidisciplinary team carefully assesses all patient-specific factors to determine the most effective treatment strategy.