**6. Conclusions**

Despite the fantastic progress in this field and the clear advantages of endovascular approaches for the ascending aorta in some clinical situations, one must bear in mind the high level of risk that these procedures entail.

Long-term data are not available to establish the safety and durability of stent-graft repairs. The cases described represent an off-label use of this technology and should be considered with the above mentioned limitations in mind.

The surgeon will need special skills in open aortic surgery and catheter based interventions to be able to plan the procedure carefully, to properly deliver the devices and to manage the potential serious complications [12].

Challenges in endograft design are the development of branched endografts and of pathologyspecific endografts [13]. However, the unique composition of the proximal thoracic aorta and the associated mechanical properties have to be taken into account and make this effort by far more complex than initially expected. Moreover, there is a need for reducing the stent-graft devices profile as well as for increasing conformability and trackability.

We believe that future advances with devices specifically designed for the treatment of ascending aorta diseases will allow this technique to be incorporated into routine medi‐ cal practice.
