Endovascular aortic repairs combined with looping-chimney technique for repairing aortic arch lesions and reconstructing left common carotid artery

Thoracic endovascular aortic repair (TEVAR) has been used as a solid alternative to conventional open surgery for many patients suffering from thoracic aortic diseases. It is most commonly used to treat descending thoracic aortic aneurysms (TAAs) and type B aortic dissection (TBAD). Core principle underpinning is to place a covered stent graft over the lesions in the descending thoracic aorta. But for aortic arch pathologies, it is usually difficult to treated with open surgery (1), and it is a challenge of TEVAR, because of insufficient (<15 mm) proximal landing zone (PLZ) and revascularization of the supra-aortic branches (SAB). Both effective exclusion of lesion and restoration of blood flow to the brain are primary concern for patients with thoracic aortic arch pathologies