Current Device Designs to Incorporate Supra-aortic Arch Trunks for Endovascular Repair

Abstract

Incorporation of aortic arch vessels with fenestrated and branched stent grafts is the last frontier for total endovascular repair of complex aortic aneurysms. The arch poses significant challenges because of its curved and angulated anatomy, proximity to the aortic valve and coronary arteries, variable anatomy of the supra-aortic trunks, and significant hemodynamic forces. Since the first repairs done with branched and fenestrated endografts, there has been increasing clinical experience and improvements in device designs. Novel developments have focused on the development of off-the-shelf designs based on branch technology. Clinical investigations are under way by several stent manufacturers using stents intended to extend the landing to zone 0 (proximal arch) and zone 2 (distal arch). This chapter summarizes some of the device specifications and indications for use.