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Jubouri et al. Vessel Plus 2023;7:5 Vessel Plus
DOI: 10.20517/2574-1209.2022.49

Review Open Access

Total endovascular aortic arch repair: is it for

everyone and where is its evidence?

1,#
2,#
3
4
1
Matti Jubouri , Mohammed Al-Tawil , Sven Z. C. P. Tan , Alexander Geragotellis , Mariam Hussain ,
5
6
Mohamad Bashir , Bashi Velayudhan , Idhrees Mohammed 6
1
Hull York Medical School, University of York, York YO10 5DD, UK.
2
Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
3
Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AD, UK.
4
Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa.
5
Vascular & Endovascular Surgery, Velindre University NHS Trust, Health Education & Improvement Wales (HEIW), Cardiff
CF15 7QZ, UK.
6
Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, Tamil Nadu
600083, India.
#
Authors contributed equally, they are joint first authors.
Correspondence to: Prof. Mohamad Bashir, Vascular & Endovascular Surgery, Velindre University NHS Trust, Health Education
& Improvement Wales (HEIW), Cardiff CF15 7QZ, UK. E-mail: drmobashir@outlook.com
How to cite this article: Jubouri M, Al-Tawil M, Tan SZCP, Geragotellis A, Hussain M, Bashir M, Velayudhan B, Mohammed I.
Total endovascular aortic arch repair: is it for everyone and where is its evidence? Vessel Plus 2023;7:5.
https://dx.doi.org/10.20517/2574-1209.2022.49
Received: 27 Jul 2022 First Decision: 23 Sep 2022 Revised: 6 Nov 2022 Accepted: 21 Feb 2023 Published: 13 Mar 2023
Academic Editor: Carlos A. Mestres Copy Editor: Fangling Lan Production Editor: Fangling Lan
Abstract
Open total arch replacement (TAR) remains the mainstay management strategy for thoracic aortic diseases
involving the aortic arch. TAR evolved from the 2-stage conventional elephant trunk (CET) technique to the hybrid
frozen elephant trunk (FET) which combined open surgical repair (OSR) with thoracic endovascular aortic repair
(TEVAR) into a 1-stage procedure. Although FET has been able to achieve superior results to CET, including
excellent survival, it still carries a risk of certain complications that may even require secondary reintervention. The
era of elephant trunk is being overtaken by the new generation of TEVAR devices being used for total endovascular
aortic arch (or endoarch) repair. Total endoarch repair (TER) is currently indicated in patients deemed high-risk for
open surgery; however, it has shown strong potential for becoming the gold stand treatment for aortic arch
pathologies. Despite the minimally-invasive nature of TER providing an obvious advantage over OSR in certain
cases, TER remains associated with comparable mortality rates and key complications such as technical failure,
neurological injury, need for reintervention, and loss of or failure to achieve target vessel patency. Upon
comprehensively searching the literature, the technical success of TER ranged from 91%-100%, mortality 0%-19%,

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