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Semin intervent Radiol 2024; 41(06): 595-600
DOI: 10.1055/s-0044-1800847
Review Article

Update on Existing and Upcoming Branched and Fenestrated Thoracic Aortic Arch Stent Grafts

Alexander A. Brescia
1   Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
Zachary J. Wanken
2   Section of Vascular Surgery, Division of General Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
J. Westley Ohman   *
2   Section of Vascular Surgery, Division of General Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
Puja Kachroo   *
1   Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
On Behalf of the Washington University Collaborative for Aortic Research (WashU-CAR) › Author Affiliations
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Abstract

Conventional management of thoracic aortic arch aneurysm and dissection with aneurysmal degeneration remains open surgical repair. However, multiple branched and fenestrated endograft systems offer promise for hybrid or total endovascular treatment of aortic arch pathology. Two zone 0 solutions involving an aortic arch with innominate branch and ascending aorta components are contemporarily in trial: the Gore thoracic branch endoprosthesis and ascending stent graft in the ARISE II Trial (W. L. Gore & Associates, Newark, Delaware) and the NEXUS Arch Stent Graft System (Endospan Ltd., Herzliya, Israel). Both device systems require a debranching procedure prior to endovascular treatment. Patients deemed appropriate for endovascular treatment with acute pathology or not qualifying for one of these trial devices may undergo homemade single or multiple fenestrated physician-modified endovascular grafts or in situ laser fenestration of aortic arch grafts with branch stenting to treat arch pathology. Ultimately, a durable total endovascular solution must achieve comparable or superior outcomes compared with open surgical repair, at significantly lower impact to patients. Branched and fenestrated endovascular treatments for aortic arch pathology require further investigation and follow-up to determine early, mid, and long-term outcomes including mortality, stroke, and endoleak requiring reintervention.

Keywords

aortic arch - aortic dissection - aortic aneurysm - TEVAR - stent graft - interventional radiology

* J.W.O. and P.K. contributed equally and are co-senior authors.




Publication History

Article published online:
04 April 2025

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  • References

  • 1 Bachet J. Open repair techniques in the aortic arch are still superior. Ann Cardiothorac Surg 2018; 7 (03) 328-344
    PubMedSearch in Google Scholar
  • 2 Roselli EE, Atkins MD, Brinkman W. et al. ARISE: first-in-human evaluation of a novel stent graft to treat ascending aortic dissection. J Endovasc Ther 2023; 30 (04) 550-560
    CrossrefPubMedSearch in Google Scholar
  • 3 Dake MD, Brinkman WT, Han SM. et al. Outcomes of endovascular repair of aortic aneurysms with the GORE thoracic branch endoprosthesis for left subclavian artery preservation. J Vasc Surg 2022; 76 (05) 1141-1149.e3
    CrossrefPubMedSearch in Google Scholar
  • 4 Basha AM, Moore RD, Rommens KL, Herget EJ, McClure RS. A systematic review of total endovascular aortic arch repair: a promising technology. Can J Cardiol 2023; 39 (01) 49-56
    CrossrefPubMedSearch in Google Scholar
  • 5 Nana P, Spanos K, Panuccio G. et al. Branched and fenestrated endovascular aortic arch repair in patients with native proximal aortic landing zone. J Vasc Surg 2024; 80 (03) 621-629.e3
    PubMedSearch in Google Scholar
  • 6 Wallen T, Carter T, Habertheuer A. et al. National outcomes of elective hybrid arch debranching with endograft exclusion versus total arch replacement procedures: Analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Aorta (Stamford) 2021; 9 (01) 21-29
    PubMedSearch in Google Scholar
  • 7 Iannacone E, Lau C, Rahouma M, Girardi L. The New York experience of open arch surgery. J Cardiovasc Surg (Torino) 2022; 63 (03) 275-280
    PubMedSearch in Google Scholar
  • 8 Settepani F, Cappai A, Basciu A, Barbone A, Tarelli G. Outcome of open total arch replacement in the modern era. J Vasc Surg 2016; 63 (02) 537-545
    CrossrefPubMedSearch in Google Scholar
  • 9 Chen JF, Ouzounian M, Peterson M. et al. Outcomes of total aortic arch replacement in a Canadian nationwide registry. Can J Cardiol 2024; 40 (07) 1326-1333
    PubMedSearch in Google Scholar
  • 10 ClinicalTrials.gov. Accessed October 6, 2024 at: https://clinicaltrials.gov/study/NCT05800743#study-overview
    PubMed
  • 11 Endospan's Nexus Aortic Arch Endovascular System Evaluated in Early TRIOMPHE IDE Study Results. Bryn Mawr Communications. January 30, 2024. Accessed October 6, 2024 at: https://evtoday.com/news/endospans-nexus-aortic-arch-endovascular-system-evaluated-in-early-triomphe-ide-study-results
    PubMed
  • 12 Holzem KM, Sanchez LA. Technical tips and clinical experience with the Terumo Relay®Branch aortic endovascular graft. J Cardiovasc Surg (Torino) 2023; 64 (01) 26-32
    PubMedSearch in Google Scholar
  • 13 Czerny M, Berger T, Kondov S. et al. Results of endovascular aortic arch repair using the Relay Branch system. Eur J Cardiothorac Surg 2021; 60 (03) 662-668
    CrossrefPubMedSearch in Google Scholar
  • 14 Dabravolskaite V, Makaloski V, Hakovirta H, Kotelis D, Schoenhoff FS, Lescan M. Evaluation of custom-made Relay® stent-grafts for aortic arch landing zones 0 and I: experience from two high-volume aortic centres. Eur J Cardiothorac Surg 2024; 66 (01) ezae241
    PubMedSearch in Google Scholar
  • 15 Bacri C, Hireche K, Alric P, Canaud L. Total aortic arch repair with double-fenestrated physician-modified endografts, at least 3-year follow-up. J Vasc Surg 2024; 80 (02) 344-354
    PubMedSearch in Google Scholar
  • 16 Pernot M, d'Ostrevy N, Piperata A, Busuttil O, Labrousse L. Percutaneous total aortic arch repair with in situ laser fenestration. Ann Thorac Surg 2022; 114 (05) e389-e392
    PubMedSearch in Google Scholar
  • 17 McKinley H, El Sayed H, Panneton J. Laser fenestration in TEVAR: Perspectives and future directions. Ann Vasc Surg 2023; 94: 119-128
    PubMedSearch in Google Scholar
  • 18 Houérou TL, Nana P, Pernot M. et al. Systematic review on in situ laser fenestrated repair for the endovascular management of aortic arch pathologies. J Clin Med 2023; 12 (07) 2496
    PubMedSearch in Google Scholar
  • 19 Li C, Xu P, Hua Z. et al. Early and midterm outcomes of in situ laser fenestration during thoracic endovascular aortic repair for acute and subacute aortic arch diseases and analysis of its complications. J Vasc Surg 2020; 72 (05) 1524-1533
    PubMedSearch in Google Scholar
  • 20 Tish S, Chase JA, Scoville C, Vogel TR, Cheung S, Bath J. A systematic review of contemporary outcomes from aortic arch in situ laser fenestration during thoracic endovascular aortic repair. Ann Vasc Surg 2023; 91: 266-274
    PubMedSearch in Google Scholar
  • 21 Barnes JA, Wanken ZJ, Columbo JA, Kuwayama DP, Fillinger MF, Suckow BD. Procedure-Associated Costs and Mid-Term Outcomes of Endovascular Zone 0 and Zone 1 Aortic Arch Repair. Ann Vasc Surg 2022; 81: 98-104
    PubMedSearch in Google Scholar