Aortic Surgery : Endovascular and Hybrid Approaches for Distal Arch and Descending Thoracic Aorta

This chapter discusses the endovascular and hybrid treatment strategies for distal arch and descending aortic pathologies. However, hybrid repairs remain popular, as robust methods and generally applicable methods of dealing with these important aortic branches. Aortic pathologies involving the distal arch and descending aorta include aneurysm, rupture, traumatic transection, penetrating ulcers, intramural hematoma, coarctation of aorta and type B dissections. Endovascular and hybrid approaches have been proposed as a less invasive method for the treatment for these pathologies. The decision on the timing of repair of descending aortic aneurysms depends on the type of technique to be used. Previous abdominal aortic surgery and concomitant visceral artery aneurysms precluded an open repair. Endovascular and hybrid therapies for arcus aorta pathologies involving the distal arch segments and descending aorta are currently performed with a low rate of late aorta-related death and reinterventions, and acceptable midterm survival, even when compared to open repair techniques.