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Ann Cardiothorac Surg. 2018 May;7(3):406-413. doi: 10.21037/acs.2018.03.13.

Status of branched endovascular aortic arch repair.

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Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, San Donato Milanese, Italy.
Department of Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA.
Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA.


Multiple medical device manufacturers are developing branched endografts for thoracic endovascular aortic repair (TEVAR), to provide a minimally invasive alternative for the treatment of aortic arch pathologies in patients who are deemed unfit for open or hybrid arch repair. Different branched endografts have been introduced, with varying number, size and orientation of the branches that redirect flow to the supra-aortic arteries. We present an overview of the currently investigated devices and review their outcomes. The results of branched TEVAR are promising, yet stroke remains the predominant periprocedural concern. For now, these procedures should be limited to select expert centers where the design and deployment procedure of branched endografts can be further developed to reduce the risk of stroke.


Thoracic endovascular aortic repair (TEVAR); aortic arch repair; branched TEVAR; stent graft design

Conflict of interest statement

Conflicts of Interest: Prof. HJ Patel serves as consultant and co-patent holder with W.L. Gore and consultant for Medtronic Inc. and Terumo Inc.; Prof. S Trimarchi serves as consultant and speaker for W.L. Gore and Medtronic Inc.; Dr. JA van Herwaarden serves as consultant and speaker for Bolton Medical, Cook Medical and Philips Health Care; Dr. J Bismuth serves as consultant and speaker for W.L. Gore. All authors declare no conflicts of interest related to the contents of the manuscript.

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