Making complex aortic repair simpler

Complex endovascular aortic repair requires careful planning at every stage, from selecting the appropriate access strategy and endograft configuration to navigating challenging anatomy, achieving accurate branch alignment and securing reliable haemostasis. As techniques evolve, the aim is not only to make complex repair possible, but to make it safer, more predictable and less invasive.

This PVI 2025 session explores practical strategies for simplifying complex aortic procedures. It examines the role and limitations of retrograde branches for arch repair, questions the need for upper-extremity access during fenestrated and branched endovascular aortic repair, and explores how steerable transfemoral access can provide an alternative while reducing procedure time, radiation exposure and potentially neurological complications. 

The session also looks at the opportunities and limitations of fusion and electromagnetic navigation, technical pitfalls in arch BEVAR—including bird-beak configuration and branch orientation—and practical approaches to percutaneous closure of carotid and axillary access.

Across these different challenges, one principle emerges: the best way to manage complex aortic repair may be to simplify the procedure wherever possible, minimise additional access and anticipate potential technical problems before they become complications.