Aortic Arch Interventions: Snorkels, Lasers, and Branches, Oh My!

1. Understand the role of advanced endovascular techniques in aortic arch repair, focusing on complex aortic arch pathologies.


2. Examine the clinical indications, procedural methodologies, and outcomes of parallel grafts (chimney/snorkel/periscope), fenestrated grafts (laser fenestration), and branched devices in the aortic arch.


3. Identify potential complications and outcomes while reviewing case examples for each technique to enhance educational and procedural success.

Aortic arch pathologies, including aneurysms, dissections, and traumatic injuries, present challenges for open surgical repair due to the complexity of the anatomy and high morbidity. Thoracic endovascular aortic repair (TEVAR) has emerged as a transformative alternative, offering less invasive options, better outcomes, reduced recovery times, and fewer complications. However, maintaining branch vessel perfusion while securing landing zones can be complex. Advanced techniques such as parallel grafts, fenestrated grafts, and branched devices are essential tools for addressing these challenges.

Parallel grafts (chimney, snorkel, periscope) extend sealing zones while preserving branch vessel patency. Fenestrated grafts, particularly with laser fenestration, offer tailored solutions for individual anatomy, and branched devices like the Gore TAG Thoracic Branch Endoprosthesis and Nexus Triomphe provide specialized technology for aortic arch interventions. 




Clinical Findings/Procedure Details:

1. Exploration of indications for parallel grafts, fenestrated grafts, and branched devices in the aortic arch. 


2. Procedural guidance on each technique, including planning, device considerations, and case outcomes.


3. Case examples demonstrating procedural approaches and outcomes for managing aortic arch pathologies.

Advanced endovascular techniques, including parallel grafts, fenestrated grafts, and branched devices, have revolutionized aortic arch repair. These minimally invasive methods preserve branch vessel perfusion and are essential for patients unsuitable for open surgery. Case examples offer practical insights into real-world applications, helping interventional radiologists refine their approaches. The continued advancement of device technology will expand possibilities for treating complex aortic arch pathologies.