Endovascular total aortic arch replacement by in situ stent graft fenestration technique

Open surgical total aortic arch replacement is a demanding procedure which carries a substantial morbidity and mortality. A less invasive endovascular option is endovascular stent grafting using in situ fenestrations. After thoracic stent graft deployment in the arch, fenestrations are made for the major arch vessels. During this procedure, antegrade cerebral perfusion is maintained using a temporary bypass from the left femoral artery to both carotids perfusing both the anterior and posterior cerebral circulation. The endovascular technique and devices used are herein described.