Percutaneous Total Aortic Arch Repair With In Situ Laser Fenestration.

Prosthetic replacement of the aortic arch requires a cardiopulmonary bypass and deep hypothermic circulatory arrest. Thus, it is associated with major perioperative risks, and custom-made devices have been developed. However, the time required for this procedure precludes emergency cases, and anatomical prerequisites limit the creation of appropriate devices. Here, we present a totally endovascular approach that allowed an exclusion of the aortic arch with the usual commercial devices. We explain, step by step, the procedure and the materials carefully selected for each step.