**5. Technical limitations**

distal landing zone. On the other hand, fusiform aneurysms have the limitation of lacking a

**Figure 11.** (A) Ascending aorta angiogram before endoprosthesis deployment showing a large pseudoaneurysm (yel‐ low arrow). (B) Ascending aorta angiogram after endoprosthesis deployment evidencing sealed pseudoaneurysm and

**Figure 10.** Coronary angiogram showing final result in right anterior oblique projection (A) and spider view (B).

Thoracic endovascular stent grafting has revolutionized the treatment of distal [type B] acute aortic dissection. Endovascular surgeons are now seeking the ways to improve the treatment of type A dissection by offering endovascular techniques to replace conventional surgical therapy. Less invasive endovascular therapy, obviates the need for sternotomy and cardio‐ pulmonary bypass, reduces perioperative morbidity, and offers an alternative solution for

sufficient landing zone in many cases.

a type 1 endoleak (red arrow).

420 Artery Bypass

Endovascular approach of the ascending aorta has several limitations and is still in its beginning phase.

The diameter of the ascending aorta is usually larger than the rest of the aorta and the proximity with the aortic valve and the presence of the coronary arteries pose special challenges.

The length of the delivery system, which is designed for the abdominal aorta, does not allow to reach the ascending aorta through the groin.

Finally, the length of the endoprosthesis itself for descending aorta may be too long to be positioned between the coronary ostia and the brachiocephalic trunk.

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