Avoiding Aortic Arch Debranching with a Custom-Made Solution a Tailored Approach to Aortic Disease

Abstract

Penetrating Atherosclerotic Ulcer (PAU) is one of the acute aortic syndromes representing a medical and surgical emergency that could lead to rapid evolution and significant complications. Depending on the aortic section involved in the PAU, the treatment with endovascular prosthesis could be challenging and often requires personalized prosthesis to face anatomical peculiarities. The aortic arch could be one of the most complex locations due to the origin of supra-aortic branches and the need for previous or subsequent carotid-subclavian bypass grafting. The use of scalloped and fenestrated prostheses makes it possible to manage aortic pathology without further vascular surgery.