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Jubouri et al. Vessel Plus 2023;7:5 https://dx.doi.org/10.20517/2574-1209.2022.49 Page 5 of 13

Figure 1. Left: Single-branched RELAY™ endoprosthesis. Middle: Double-branched RELAY™ endoprosthesis. Right: Triple-branched
RELAY™ endoprosthesis. Figure reused from Terumo Aortic website.

Figure 2. Examples of commercially available TER endoprostheses. (A) Zenith A-branch, (B) TAG Thoracic Branch Endoprosthesis, (C)
Terumo Aortic RELAY Plus Double Branched device, and (D) Najuta. Reproduced from Fujimura et al. [46] , no copyright permission is
required (STM signatory).

Fenestrated TEVAR is another approach that has been established in treating arch pathologies while
maintaining supra-aortic vessel perfusion. The Japanese Najuta™ pre-curved fenestrated stent graft is an
example of fenestrated TEVAR used in TER. The Najuta™ system does not have bridging stents to fixate the
fenestrations at the target-vessel ostia . Another fenestrated arch endograft, the Zenith™ device from Cook
[33]
Medical, uses a preloaded wire system combining a fenestration and a scallop with a covered bridging stent
to fixate the fenestration to the left common carotid artery or LSA as the target vessel . The distance from
[34]
the femoral vessel and the curvature of the arch make the rotation of the fenestrated devices more
challenging. Thus, the precision of placement requires meticulous preoperative planning and technical
skills. Therefore, the arch branched devices remain more suitable for arch diseases, especially in cases of
[34]
extended or complex disease .

Criteria for total endovascular arch repair
Despite the great potential shown by TER, OSR remains the mainstay for the treatment of aortic arch
pathologies until now. Still, there are groups of patients with certain demographics and disease