Hybrid and total endovascular repair of the aortic arch. BJS 2018; 105: 315-327.

Results

Hybrid arch repair is associated with an early mortality rate of some 12 per cent, and carries significant risk of stroke (up to 15 per cent), paraplegia (up to 6 per cent), retrograde dissection (up to 6·5 per cent) and proximal endoleak (6 per cent). Despite patients being of overall higher perioperative risk, hybrid repair has morbidity and early mortality rates comparable to those of open arch replacement. However, rates of freedom from aortic rupture or reintervention are significantly lower in the longer term, owing to the incidence of endoleak. Total endovascular arch repair may be achieved by the use of parallel stents or in situ fenestration in the emergency setting, or use of custom‐made devices (scalloped, fenestrated or branched stent‐grafts) in the elective setting. Reports of these relatively novel technologies suggest acceptable short‐term outcomes, but long‐term data are still awaited.