الفهرس 
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Abstract
Aortic arch pathologies are relatively uncommon, many of the patients are either asymptomatic or otherwise had catastrophic lifethreatening events. These include degenerative aneurysms and the acute aortic syndromes (e.g., penetrating ulcers, intramural hematoma and aortic dissections)
Imaging studies are the main tool for the diagnosis and assessment of aortic pathologies, as they provide accurate data about
MDCT scans and are the gold-standard method for radiological diagnosis of aortic pathologies, replacing classical invasive angiography. MRA the most accurate and reliable method for diagnosis of aortic diseases with a sensitivity and specificity of 100%. However, MRA is significantly slower than a CT scan not suitable for critical patients. TTE provides data about the condition of the heart function, pericardial effusion and, presence and severity of aortic regurgitation on the other hand, TOE is as reliable as a CT/MRA scan and it is suitable for unstable patients who cannot be transferred. the validity of a TOE is similar to that of a CT/MRA; but TOE is operator dependent.
Over decades, Open aortic arch surgery shows an improvement in mortality and neurological complications. some patient deemed inoperable due to their comorbidities and other high-risk features like old age, fragility, and previous cardiac surgery. Treating aortic arch pathologies are complex and pose a substantial challenge to the cardiovascular surgeons as These Surgical techniques combine a variable number of adjuvants including full cardiopulmonary bypass, cerebrospinal fluid drainage, distal aortic perfusion, brain protection, and deep hypothermia, with or without circulatory arrest. With increased incidence of many complications such as spinal cord ischemia, re intervention for bleeding, renal failure, and early mortality.
The main advantage of TEVAR in aortic arch intervention is decreased perioperative morbidity and mortality either in elective or emergency cases specially in elderly frail patients. The hybrid arch repair is established by debranching of arch vessels first, then stentgraft deployment in the native aorta. With increased technical success and experience, a decreased incidence of neurological complication.
Numerous different techniques and approaches employed for HAR which aim to exclude the diseased part of the aorta. Due to the shape of the aortic arch and crowding of supra-aortic vessels in a tight space, HAR entails debranching of aortic arch branches to create a sufficient landing zone and this can be done in a simultaneous or staged procedure. Then TEVAR can be performed simply and safely using percutaneous retrograde access from the femoral artery.
These procedures can be performed in the operating room, catheterization suite, or hybrid room depending on the clinical scenario and facility availability.
Despite the increasing application of endovascular treatment in aortic arch diseases over the last decade, there is conflicting information as to the early safety with respect to patients’ selection and disease extension, while the long-term durability remains largely unsettled. Currently, the best approach to the aortic arch remains unsupported by robust evidence. Most of the available data rely on small sample numbers, heterogeneous settings, and limited follow-up.