Complete Endovascular Repair of Entire Aorta for Extensive Pathologies — A Set of China Strategies

Abstract

Background

Endovascular aortic repair was introduced in China in 1997, with domestically produced devices emerging post-2000. Despite progress, treatment of complex aortic pathologies remains limited, necessitating innovative endovascular solutions.

Methods

Our center developed 8 off-the-shelf endovascular innovations, including 3 inner branch stent graft systems for aortic arch reconstruction, 2 branched/fenestrated stent grafts for thoracoabdominal and juxtarenal aortic aneurysms, 1 iliac branch device for internal iliac artery preservation, and 2 novel devices—EndoPatch and EndoSeal (Endonom Medtech)—designed to seal distal tears and occlude false lumen in aortic dissections. These advancements integrate technologies such as steerable delivery systems, preloaded navigation aids, and mixed or inner branch configurations to accommodate anatomical variations.

Results

Preliminary clinical applications demonstrated promising technical success rates and acceptable complication profiles. Two devices have been approved by China’s National Medical Products Administration for clinical use, while others remain under investigation. Key challenges include anatomical variability, branch vessel patency concerns, and the absence of long-term outcomes for most devices.

Conclusion

These innovations establish a comprehensive endovascular strategy for extensive aortic pathologies, addressing critical gaps in China’s device landscape. Early outcomes demonstrate the feasibility of standardized off-the-shelf solutions for complex anatomies, though multicenter trials and long-term follow-up remain essential to confirm safety and efficacy.