Total endovascular aortic arch repair: a comprehensive review comparing parallel graft techniques and custom-made devices

INTRODUCTION: Endovascular approaches have emerged as promising alternatives for treating aortic arch pathology, particularly in high-risk patients. This review provides a comprehensive analysis of total endovascular aortic arch reconstruction, focusing on Parallel Graft Techniques (PGTs) and Custom-Made Devices (CMDs). METHODS: PubMed and Scopus were searched to conduct a comprehensive review comparing the technical aspects, clinical outcomes, strengths, and limitations of PGTs and CMDs. Only studies reporting on total endovascular aortic aneurysm repair were considered. Studies with fewer than five patients, published in a language other than Portuguese, English, or Spanish, and reporting hybrid/open procedures or partial aortic arch reconstructions were excluded. Findings were summarised descriptively. RESULTS: A total of 38 studies comprising 871 patients were included (214 in PGT and 657 in the CMD group). Technical success rates were high in both groups, mostly ranging from 80%80% to 100%100%. No clear superiority was observed between the two approaches for thirty-day, aorta-related, or overall mortality. However, stroke and spinal cord ischaemia (SCI) rates appeared higher in the CMD group, ranging from 0 to 42.9%42.9% and 0 to 9.1%9.1% respectively. The occurrence of type I and III endoleaks was higher in the PGT group (0-45.5% versus 0-32.4%), though this did not translate into a clear difference in reintervention rates. During follow-up, high target vessel patency rates were observed in both groups, typically exceeding 95%95% . CONCLUSION: PGTs appear to have non-inferior outcomes in terms of stroke rate and in-hospital and overall mortality. Although the occurrence of type I/III endoleaks remains higher in PGTs, this does not seem to affect reintervention rates. Thus, PGTs should be considered a viable option for treating complex aortic arch pathology, particularly in fragile patients, those with adverse anatomy, or in emergent situations. Large-volume prospective studies directly comparing these two techniques are currently warranted.