Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS)

The last decade has substantially broadened treatment options for patients with thoracic aortic pathology involving the aortic arch. Traditionally, treatment of aortic arch pa- thology was a domain of open cardiac surgery. The advent of combined vascular and endovascular procedures opened a new fi eld thereby enabling treatment in previously operated on and in less fi t patients. As a subsequent technological leap, branched arch stent grafts became available and are currently gaining acceptance in the com- munity. Also, open surgery has substantially improved, and the increased use of right subclavian artery cannulation and selective antegrade cerebral perfusion (SACP) at warmer lower body circulatory arrest times together with improved monitoring of organ function has substantially contributed to excellent results in these still major operations. Still, neurological complications remain a major concern of all procedures addressing aortic arch pathology irrespective if open surgery or endovascular repair. The reduction of neurological complications to a minimum will be one of the major tasks of the future