Hybrid and Total Endovascular Solutions for Aortic Arch Disease: Contemporary Surgical Strategies

TL;DR

This paper discusses modern surgical approaches for treating aortic arch disease, focusing on hybrid and endovascular techniques.

Contribution

The paper highlights the evolution and current state of hybrid and total endovascular solutions for aortic arch disease.

Findings

Antegrade cerebral perfusion has reduced neurological complications in aortic arch surgery.

Hybrid stent graft systems have simplified arch reconstruction and expanded treatment options.

Total endovascular repair has high early stroke rates and limited long-term durability data.

Abstract

Aortic arch diseases represent one of the most complex domains in cardiovascular surgery due to the need for cerebral protection, anatomical precision, and durable reconstruction. Their management requires highly individualized strategies that balance cerebral protection, systemic organ perfusion, anatomical complexity, and long-term durability. Over recent decades, antegrade cerebral perfusion has significantly reduced neurological morbidity. In parallel, vascular prostheses have progressed from conventional Dacron grafts to hybrid stent graft systems simplifying arch reconstruction and expanded treatment options in high-risk cohorts. Total endovascular arch repair using branched or fenestrated devices has emerged for selected high-risk patients; however, current data remain limited, with early stroke rates of approximately 5–8% and restricted long-term durability evidence. From both clinical and economic perspectives, open and hybrid approaches remain central to durable arch management.

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