Aortic Arch Aneurysms

Aortic arch aneurysms present a special challenge to the cardiovascular surgeon because of the complicated anatomy of the aortic arch and critical need to protect the brain from ischemic and embolic injury during aortic arch aneurysm repair. Over the past 30 years, advances in operative technique and neuroprotective strategies have made routine repair of aortic arch aneurysms feasible. The development of endostents to treat aortic arch aneurysms has been delayed by anatomic constraints, such as the curvature of this aortic segment and critical branches to the brain that need to be reconstructed. The initial use of endostents to treat aortic arch pathology has been primarily in the context of hybrid endovascular-open procedures. Ongoing development of branched endografts will add to the therapeutic options for the treatment of the aortic arch aneurysms and improve the safety and outcomes of this procedure.