Endovascular arch repair: Endograft design options and worldwide results

Abstract OBJECTIVES This review evaluates procedural and technical advancements in branched and fenestrated thoracic endovascular aortic repair (B-/F-TEVAR) for aortic arch pathologies, with the main focus on the clinical outcomes, including stroke and mortality. METHODS A narrative review of the literature was conducted to assess the evolution of B-/F-TEVAR devices, including branched and fenestrated designs. Key factors such as technical success, perioperative outcomes, and long-term performance were examined across various patient cohorts with the focus on mortality and stroke. RESULTS B-/F-TEVAR achieves high technical success rates (84%–100%), with 30-day mortality and stroke rates typically ranging from 0%–25% and 3%–36%, respectively. Fenestrated repairs are particularly suited for pathologies involving the lesser aortic curvature, offering reduced mortality (as low as 2% in some studies), while branched repairs provide greater adaptability for complex anatomies, albeit with higher stroke rates in certain cohorts. CONCLUSIONS B-/F-TEVAR has emerged as a feasible treatment option for selected high-risk patients with aortic arch pathology, achieving high technical success. Although outcomes may improve with growing experience, stroke remains a significant complication, and reintervention rates highlight the need for long-term durability.