The Zenith arch branch graft (Cook Medical) was designed to target arch aneurysm and chronic dissection patients. The Zenith arch branch graft (A) with views from the abluminal side from above (B) and the luminal side from the proximal end of the graft (C). It is important to note that the inner branch graft is investigational and not available commercially.įigure 1. However, research and development efforts were significantly aided by these early learning experiences, and in 2009, Cook designed an inner branch arch endovascular graft, which was specifically aimed to overcome the recognized challenges of endovascular arch repair while offering high-risk patients a durable treatment option. Specifically, the use of scallops and fenestrations in early designs proved extremely difficult due to the excessive manipulation needed to align these features with their appropriate branch vessels. Although early versions proved clinically useful when the devices were appropriately delivered, they were hampered by technical difficulties, and extensive use was hindered due to associated peri- and postoperative complications. Over the past 15 years, Cook has produced several iterations of devices to treat the aortic arch from an endovascular approach. This article reflects the experience to date with the Cook Medical platform, and others are described in the accompanying Aortic Arch Technologies in Development sidebar. The ability to repair the aortic arch via endovascular means has clear advantages in that: (1) the surgery is done via a minimally invasive approach with no sternotomy or ministernotomy needed (2) the procedure is done under general anesthesia without the use of hypothermic circulatory arrest and (3) cardiopulmonary bypass is not required.Ĭurrently, there are no commercially available endovascular grafts for total arch repair however, several manufacturers have introduced designs through the custom-made device process in Europe and the early feasibility process within the United States. Open surgical repair remains the gold standard of care for complete aortic arch replacement however, alternative, less invasive procedures continue to show promise in treating the aortic arch due to their ability to decrease surgical morbidity and mortality.
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