How is Aortic Dissection & Aneurysm involving aortic arch treated?

Addressing pathology in the aortic arch could happen in one of many ways. Could happen with a completely open operation when you open somebody's chest and addressing the pathology head on or could be done with an endovascular means, that means a stent, or it could be a combination of the two. Just to give you kind of a quick summary of the anatomy that we're dealing with, so once you open the chest, here's the arch vessels that are very important to maintain. The heart is not far from the area of interest, so really you need to focus on maintaining blood flow to the brain while not jeopardizing anything before that going into the heart or the heart blood vessels, the coronary arteries. So the open repair would stop the heart, which is called cardiac standstill and cardiopulmonary bypass and circulatory arrest, and replace all the disease pathology with a full arch repair and that has a good success record based on the center and the surgeon volume. The alternative to that is a total endovascular repair where you bring in the endograft again from the, or the stent, you bring the stent all the way from the groin up to the arch And this stent would have been custom made based on the CT scan on the patient's anatomy. Either has holes, we call fenestrations, or have branches that we take all the way across the blood vessels of the arch, and then you can definitely then maintain the blood flow to the arch vessels through these holes or branches. It's technically more demanding in terms of stenting. It has to be also done in certain centers and done a good amount of aortic arch work by experienced providers. Now what combines these two is the hybrid repair where you do a component of it with a stent and another component with a bypass or an open operation. So these ARJ vessels could be a bypass from either the ascending aorta or one to the other from the descending aorta, kind of what we call retrograde bypass from any combination of these vessels and creating an area where there is a maintained blood flow to the art vessels and you bring up the endograft and you cover the rest that is not jeopardizing the blood flow to the brain.