Is There a Place for Endovascular Treatment in Aortic Arch Pathology?

Abstract

BACKGROUND: Aortic arch stenting appears to be a debatable topic among cardiac surgeons, cardiologists and interventional radiologists. During the last decade a variety of products of endovascular treatment has been applied either to open heart surgery or to hybrid management of aortic arch pathology. In general, fenestrated, bare and multilayer stents are separate issues to be investigated, in contrary to covered stents which seem to gain their place in cardiovascular operations. Additionally new sophisticated devices and methods derived from current literature, e.g. Djumbodis, E-xl, BOS, Frozen elephant trunk (EVITA OPEN), & Cardiatis, promote the idea of hybrid treatment of aortic arch pathology.

 AIM, METHODS & RESULTS: The primary purpose in our presentation is to discuss several aspects of aortic arch stenting and to investigate the possibility of performing less invasive operations by the use of evolutionary facilities in order to define the spectrum of indications and to improve decision making. Currently there is no adequate evidence (level A or B) to develop guidelines for the management of acute aortic syndromes and thoracic aneurysms. According to several articles in the literature, endovascular interventions and hybrid repairs seem to approach or even to decrease the rate of mortality and morbidity in comparison to open surgical procedures and medical treatments. On the other hand, many reports in current literature indicate that conventional aortic arch surgery or conservative treatment are superior to stenting, thus creating a foggy field for a well established decision making.

 CONCLUSION: Thus, for endovascular or hybrid treatment of aortic arch pathology, these new technological entities in pair to previous applied methods should be studied further in multicenter prospective randomized trials in order to create a safe treatment environment.