**14. Total aortic repair**

Deployment of stent in the descending thoracic aorta has its drawbacks. Stent induced false lumen thrombosis activated inflammatory markers like metalloproteinases and proinflammatory cytokines [48], which contribute in the progression of aneurysm by destruction of the extracellular matrix in the aortic wall and neoangiogenesis. Risk factors for the late development of aneurysm include (i) patent

false lumen, (ii) helicoidal flow distal to the endoprosthesis, (iii) aortic wall shear stress gets modified.

Matalanis [49] has introduced the concept of total aortic repair to prevent the above mentioned complication. Patients presenting with TAAD and a descending thoracic aorta diameter of more than 40 mm can benefited from this approach. The repair involves a "Branch first "total aortic arch repair and surgical ascending aorta repair. Second part included endovascular treatment of descending aorta. It includes covered stent graft deployment in the proximal part of descending aorta and rupture of the intimal flap for the last part of aorta. The rupture is managed with the deployment and dilation under balloon of uncovered stent graft. With this approach, aneurysmal dilatation of the false channel is avoided by the creation of this new aortic channel. But, currently there is no long-term follow-up of this approach.
