Advances in management of aortic arch in type A aortic dissection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

AILIYAER Ainiwaer ¹ ,  MAIMAITIAILI Azezi ²

1. Graduate School of Xinjiang Medical University, Urumqi 830017, P. R. China;
2. Department of Cardiac Surgery, Xinjiang Uygur Autonomous Region People’s Hospital, Urumqi 830001, P. R. China;

Corresponding author：

MAIMAITIAILI Azezi, Email: 12090807@qq.com

Keywords：

aortic dissection; aortic arch management; open surgery; endovascular repair; hybrid procedures

DOI：

10.7507/1007-9424.202506016

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To review current research on aortic arch management strategies in type A aortic dissection (TAAD) and provide a reference for surgical decision-making. Methods A comprehensive literature search was conducted on aortic arch management techniques globally. Results Current research shows three managment for type A aortic dissection surgical startegies:open surgery remains the gold standard but is associated with elevated perioperative mortality and significant postoperative complication rates;endovascular repair,while demonstrating reduced complication incidence, presents substantial technical challenges that hinder widespread clinical adoption;Hybrid procedures exhibit lower acute complication rates, yet long-term outcomes remain uncertain. Conclusions As one of the most lethal emergencies of cardiovascular surgery , TAAD requires immediate intervention. While open surgery is the current gold standard, it presents clinical challenges including elevated mortality and morbidity. Future research must focus on reducing operative duration without compromising success rates.

1.	Zhu Y, Lingala B, Baiocchi M, et al. Type A aortic dissection—experience over 5 decades: JACC historical breakthroughs in perspective. J Am Coll Cardiol, 2020, 76(14): 1703-1713.
2.	Obel LM, Lindholt JS, Lasota AN, et al. Clinical characteristics, incidences, and mortality rates for type A and B aortic dissections: a nationwide Danish population-based cohort study from 1996 to 2016. Circulation, 2022, 146(25): 1903-1917.
3.	Mori Y, Hirose H, Takagi H, et al. Aortic arch repair for Stanford type A aortic dissection with distal anastomosis to the proximal level of the distal aortic arch. J Thorac Cardiovasc Surg, 2003, 126(2): 415-419.
4.	Harris KM, Nienaber CA, Peterson MD, et al. Early mortality in type A acute aortic dissection: insights from the international registry of acute aortic dissection. JAMA Cardiol, 2022, 7(10): 1009-1015.
5.	Marquis KM, Naeem M, Rajput MZ, et al. CT of postoperative repair of the ascending aorta and aortic arch. Radiographics, 2021, 41(5): 1300-1320.
6.	Benedetto U, Dimagli A, Kaura A, et al. Determinants of outcomes following surgery for type A acute aortic dissection: the UK national adult cardiac surgical audit. Eur Heart J, 2021, 43(1): 44-52.
7.	Vervoort D, An KR, Deng MX, et al. The call for the “Interventional/Hybrid” aortic surgeon: open, endovascular, and hybrid therapies of the aortic arch. Can J Cardiol, 2024, 40(3): 478-495.
8.	Spath P, Campana F, Tsilimparis N, et al. Outcomes of fenestrated and branched endografts for partial and total endovascular repair of the aortic arch—a systematic review and meta-analysis. Eur J Vasc Endovasc Surg, 2024, 67(1): 106-116.
9.	Helder MRK, Schaff HV, Day CN, et al. Regional and temporal trends in the outcomes of repairs for acute type A aortic dissections. Ann Thorac Surg, 2020, 109(1): 26-33.
10.	Hughes GC, Chen EP, Browndyke JN, et al. Cognitive effects of body temperature during hypothermic circulatory arrest trial (GOT ICE): a randomized clinical trial comparing outcomes after aortic arch surgery. Circulation, 2024, 149(9): 658-668.
11.	Sun L, Qi R, Zhu J, et al. Total arch replacement combined with stented elephant trunk implantation: a new “standard” therapy for type a dissection involving repair of the aortic arch?. Circulation, 2011, 123(9): 971-978.
12.	冯丽, 田学丽, 王学廷, 等. MSCT血管成像对主动脉弓分支变异的解剖学研究及临床应用. 实用放射学杂志, 2014, 30(3): 430-433.
13.	Aizawa K, Kawahito K, Misawa Y. Long-term outcomes of tear-oriented ascending/hemiarch replacements for acute type A aortic dissection. Gen Thorac Cardiovasc Surg, 2016, 64(7): 403-408.
14.	Heuts S, Adriaans BP, Kawczynski MJ, et al. Editor’s choice—Extending aortic replacement beyond the proximal arch in acute type A aortic dissection: a meta-analysis of short term outcomes and long term actuarial survival. Eur J Vasc Endovasc Surg, 2022, 63(5): 674-687.
15.	Norton EL, Wu X, Kim KM, et al. Is hemiarch replacement adequate in acute type A aortic dissection repair in patients with arch branch vessel dissection without cerebral malperfusion?. J Thorac Cardiovasc Surg, 2021, 161(3): 873-884.
16.	Borst HG, Walterbusch G, Schaps D. Extensive aortic replacement using “elephant trunk” prosthesis. Thorac Cardiovasc Surg, 1983, 31(1): 37-40.
17.	Crawford ES, Coselli JS, Svensson LG, et al. Diffuse aneurysmal disease (chronic aortic dissection, Marfan, and mega aorta syndromes) and multiple aneurysm. Treatment by subtotal and total aortic replacement emphasizing the elephant trunk operation. Ann Surg, 1990, 211(5): 521-537.
18.	Watanuki H, Ogino H, Minatoya K, et al. Is emergency total arch replacement with a modified elephant trunk technique justified for acute type A aortic dissection?. Ann Thorac Surg, 2007, 84(5): 1585-1591.
19.	Inoue Y, Matsuda H, Omura A, et al. Comparative study of the frozen elephant trunk and classical elephant trunk techniques to supplement total arch replacement for acute type A aortic dissection†. Eur J Cardiothorac Surg, 2019, 56(3): 579-586.
20.	Kato M, Ohnishi K, Kaneko M, et al. New graft-implanting method for thoracic aortic aneurysm or dissection with a stented graft. Circulation, 1996, 94(9 Suppl): Ⅱ188-Ⅱ193. doi: 10.1159/000108060.
21.	Mizuno T, Toyama M, Tabuchi N, et al. Stented elephant trunk procedure combined with ascending aorta and arch replacement for acute type A aortic dissection. Eur J Cardiothorac Surg, 2002, 22(4): 504-509.
22.	孙立忠, 刘志刚, 常谦, 等. 主动脉弓替换加支架 “象鼻” 手术治疗 Stanford A 型主动脉夹层. 中华外科杂志, 2004, 42(13): 812-816.
23.	Zhang K, Qiu J, Wu J, et al. Long-term outcomes in total arch replacement combined with frozen elephant trunk for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2025, 170(4): 994-1005.
24.	Tian DH, Ha H, Joshi Y, et al. Long-term outcomes of the frozen elephant trunk procedure: a systematic review. Ann Cardiothorac Surg, 2020, 9(3): 144-151.
25.	Preventza O, Liao JL, Olive JK, et al. Neurologic complications after the frozen elephant trunk procedure: a meta-analysis of more than 3000 patients. J Thorac Cardiovasc Surg, 2020, 160(1): 20-33.
26.	Mazzolai L, Teixido-Tura G, Lanzi S, et al. 2024 ESC guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J, 2024, 45(36): 3538-3700.
27.	陈良万, 卢琳, 戴小幅, 等. 单分支支架血管植入技术在急性A型主动脉夹层全弓替换加支架象鼻植入术中的应用. 中华医学杂志, 2011, 91(48): 3435-3437.
28.	孙勇新, 赖颢, 张致琦, 等. Fontus 术中支架在急性A型主动脉夹层中的应用. 中华血管外科杂志, 2018, 3(2): 78-83.
29.	Chen LW, Wu XJ, Dai XF, et al. A self-adaptive triple-branched stent graft for arch repair during open type A dissection surgery. J Thorac Cardiovasc Surg, 2015, 149(5): 1278-1283.
30.	严亮亮, 陈银海, 陈良万. 三分支支架血管重建主动脉弓的中远期效果. 学创新, 2017, 14(33): 32-35.
31.	Di Bartolomeo R, Pantaleo A, Berretta P, et al. Frozen elephant trunk surgery in acute aortic dissection. J Thorac Cardiovasc Surg, 2015, 149(2 Suppl): S105-S109. doi: 10.1016/j.jtcvs.2014.07.098.
32.	戴路, 邱家伟, 马明星, 等. 应用一体化免缝合带支架人工血管系统治疗主动脉夹层. 中华医学杂志, 2021, 101(12): 872-877.
33.	蒋斌, 刘永春, 郑晓宇, 等. 免缝合技术在主动脉疾病手术中的运用. 血管与腔内血管外科杂志, 2024, 10(5): 623-627.
34.	郑晓宇, 蒋斌, 叶仕高, 等. 免缝合技术治疗急性A型主动脉夹层. 中华胸心血管外科杂志, 2024, 40(8): 459-463.
35.	靳凯悦, 乔环宇, 李晓南, 等. 腋股动脉联合插管在主动脉夹层孙氏手术中的应用. 中华胸心血管外科杂志, 2019, 35(11): 680-683.
36.	Takagi H, Umemoto T; ALICE Group. A meta-analysis of total arch replacement with frozen elephant trunk in acute type A aortic dissection. Vasc Endovascular Surg, 2016, 50(1): 33-46.
37.	Norton EL, Wu X, Kim KM, et al. Unilateral is comparable to bilateral antegrade cerebral perfusion in acute type A aortic dissection repair. J Thorac Cardiovasc Surg, 2020, 160(3): 617-625.
38.	Qiu J, Wu J, Xie E, et al. Surgical management and outcomes of the aortic root in acute type A aortic dissection. Ann Thorac Surg, 2020, 110(1): 136-143.
39.	蒋小浪, 董智慧, 符伟国. 腔内修复治疗Stanford A型主动脉夹层的现状与挑战. 中华外科杂志, 2023, 61(12): 1046-1050.
40.	Ferraresi M, Katsarou M, Luigi Molinari AC, et al. Endovascular repair of ascending aortic pathologies in patients unfit for open surgery: case series and literature review. J Vasc Surg Cases Innov Tech, 2024, 10(3): 101455. doi: 10.1016/j.jvscit.2024.101455.
41.	Yuan X, Mitsis A, Mozalbat D, et al. Alternative management of proximal aortic dissection: concept and application. Indian J Thorac Cardiovasc Surg, 2022, 38(Suppl 1): 183-192.
42.	Shigihara S, Shirakabe A, Okazaki H, et al. Successful treatment of a patient with type-A acute aortic dissection with emergent percutaneous coronary intervention and thoracic endovascular aortic repair under percutaneous cardiopulmonary support: a case report. Eur Heart J Case Rep, 2022, 6(9): ytac344. doi: 10.1093/ehjcr/ytac344. doi: 10.1093/ehjcr/ytac344. doi: 10.1093/ehjcr/ytac344.doi:10.1093/ehjcr/ytac344.
43.	Uchida T, Kuroda Y, Yamashita A, et al. Clinical experience of endovascular stent-graft treatment for stanford type A acute aortic dissection. Kyobu Geka, 2019, 72(12): 976-983.
44.	Nagashima H, Sugiyama T, Kondo N, et al. Successful application of angioembolization and thoracic endovascular aortic repair (TEVAR) in a retrograde type-A acute aortic dissection with polytrauma. Trauma Case Rep, 2021, 37: 100571. doi: 10.1016/j.tcr.2021.100571.
45.	Muetterties CE, Conklin JH, Moser GW, et al. Right axillary artery cannulation for endovascular repair of an acute type A aortic dissection. Innovations (Phila), 2017, 12(2): 140-143.
46.	Canaud L, Morishita K, Gandet T, et al. Homemade fenestrated stent-graft for thoracic endovascular aortic repair of zone 2 aortic lesions. J Thorac Cardiovasc Surg, 2018, 155(2): 488-493.
47.	Qin J, Zhao Z, Liu G, et al. In situ diode laser fenestration of aortic arch stent grafts during thoracic endovascular aortic repair of Stanford type A aortic dissection. EuroIntervention, 2019, 14(18): e1854-e1860. doi: 10.4244/EIJ-D-18-00710.
48.	Ujihira K, Kemmochi R, Matsumoto T, et al. Sandwich technique for endovascular repair of type A aortic dissection following stent graft with an inner branch in the ascending aorta. J Vasc Surg Cases Innov Tech, 2025, 11(2): 101735. doi: 10.1016/j.jvscit.2025.101735.
49.	De Freitas S, Rossi MJ, Abramowitz SD, et al. Systematic review and meta-analysis of endovascular interventions for Stanford type A aortic dissection. J Vasc Surg, 2021, 74(5): 1721-1731.
50.	Ahmed Y, Houben IB, Figueroa CA, et al. Endovascular ascending aortic repair in type A dissection: a systematic review. J Card Surg, 2021, 36(1): 268-279.
51.	国家心血管病专家委员会血管外科专业委员会. 杂交技术治疗累及弓部主动脉病变的中国专家共识. 中国循环杂志, 2020, 35(2): 124-130.
52.	Czerny M, Pacini D, Aboyans V, et al. Current options and recommendations for the use of thoracic endovascular aortic repair in acute and chronic thoracic aortic disease: an expert consensus document of the European Society for Cardiology (ESC) Working Group of Cardiovascular Surgery, the ESC Working Group on Aorta and Peripheral Vascular Diseases, the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg, 2021, 59(1): 65-73.
53.	Sule J, Chua CR, Teo C, et al. Hybrid type Ⅱ and frozen elephant trunk in acute Stanford type A aortic dissections. Scand Cardiovasc J, 2022, 56(1): 91-99.
54.	Takayama H, Hohri Y, Brinster DR, et al. Open, endovascular or hybrid repair of aortic arch disease: narrative review of diverse strategies with diverse options. Eur J Cardiothorac Surg, 2024, 65(6): ezae179. doi: 10.1093/ejcts/ezae179.

1. Zhu Y, Lingala B, Baiocchi M, et al. Type A aortic dissection—experience over 5 decades: JACC historical breakthroughs in perspective. J Am Coll Cardiol, 2020, 76(14): 1703-1713.
2. Obel LM, Lindholt JS, Lasota AN, et al. Clinical characteristics, incidences, and mortality rates for type A and B aortic dissections: a nationwide Danish population-based cohort study from 1996 to 2016. Circulation, 2022, 146(25): 1903-1917.
3. Mori Y, Hirose H, Takagi H, et al. Aortic arch repair for Stanford type A aortic dissection with distal anastomosis to the proximal level of the distal aortic arch. J Thorac Cardiovasc Surg, 2003, 126(2): 415-419.
4. Harris KM, Nienaber CA, Peterson MD, et al. Early mortality in type A acute aortic dissection: insights from the international registry of acute aortic dissection. JAMA Cardiol, 2022, 7(10): 1009-1015.
5. Marquis KM, Naeem M, Rajput MZ, et al. CT of postoperative repair of the ascending aorta and aortic arch. Radiographics, 2021, 41(5): 1300-1320.
6. Benedetto U, Dimagli A, Kaura A, et al. Determinants of outcomes following surgery for type A acute aortic dissection: the UK national adult cardiac surgical audit. Eur Heart J, 2021, 43(1): 44-52.
7. Vervoort D, An KR, Deng MX, et al. The call for the “Interventional/Hybrid” aortic surgeon: open, endovascular, and hybrid therapies of the aortic arch. Can J Cardiol, 2024, 40(3): 478-495.
8. Spath P, Campana F, Tsilimparis N, et al. Outcomes of fenestrated and branched endografts for partial and total endovascular repair of the aortic arch—a systematic review and meta-analysis. Eur J Vasc Endovasc Surg, 2024, 67(1): 106-116.
9. Helder MRK, Schaff HV, Day CN, et al. Regional and temporal trends in the outcomes of repairs for acute type A aortic dissections. Ann Thorac Surg, 2020, 109(1): 26-33.
10. Hughes GC, Chen EP, Browndyke JN, et al. Cognitive effects of body temperature during hypothermic circulatory arrest trial (GOT ICE): a randomized clinical trial comparing outcomes after aortic arch surgery. Circulation, 2024, 149(9): 658-668.
11. Sun L, Qi R, Zhu J, et al. Total arch replacement combined with stented elephant trunk implantation: a new “standard” therapy for type a dissection involving repair of the aortic arch?. Circulation, 2011, 123(9): 971-978.
12. 冯丽, 田学丽, 王学廷, 等. MSCT血管成像对主动脉弓分支变异的解剖学研究及临床应用. 实用放射学杂志, 2014, 30(3): 430-433.
13. Aizawa K, Kawahito K, Misawa Y. Long-term outcomes of tear-oriented ascending/hemiarch replacements for acute type A aortic dissection. Gen Thorac Cardiovasc Surg, 2016, 64(7): 403-408.
14. Heuts S, Adriaans BP, Kawczynski MJ, et al. Editor’s choice—Extending aortic replacement beyond the proximal arch in acute type A aortic dissection: a meta-analysis of short term outcomes and long term actuarial survival. Eur J Vasc Endovasc Surg, 2022, 63(5): 674-687.
15. Norton EL, Wu X, Kim KM, et al. Is hemiarch replacement adequate in acute type A aortic dissection repair in patients with arch branch vessel dissection without cerebral malperfusion?. J Thorac Cardiovasc Surg, 2021, 161(3): 873-884.
16. Borst HG, Walterbusch G, Schaps D. Extensive aortic replacement using “elephant trunk” prosthesis. Thorac Cardiovasc Surg, 1983, 31(1): 37-40.
17. Crawford ES, Coselli JS, Svensson LG, et al. Diffuse aneurysmal disease (chronic aortic dissection, Marfan, and mega aorta syndromes) and multiple aneurysm. Treatment by subtotal and total aortic replacement emphasizing the elephant trunk operation. Ann Surg, 1990, 211(5): 521-537.
18. Watanuki H, Ogino H, Minatoya K, et al. Is emergency total arch replacement with a modified elephant trunk technique justified for acute type A aortic dissection?. Ann Thorac Surg, 2007, 84(5): 1585-1591.
19. Inoue Y, Matsuda H, Omura A, et al. Comparative study of the frozen elephant trunk and classical elephant trunk techniques to supplement total arch replacement for acute type A aortic dissection†. Eur J Cardiothorac Surg, 2019, 56(3): 579-586.
20. Kato M, Ohnishi K, Kaneko M, et al. New graft-implanting method for thoracic aortic aneurysm or dissection with a stented graft. Circulation, 1996, 94(9 Suppl): Ⅱ188-Ⅱ193. doi: 10.1159/000108060.
21. Mizuno T, Toyama M, Tabuchi N, et al. Stented elephant trunk procedure combined with ascending aorta and arch replacement for acute type A aortic dissection. Eur J Cardiothorac Surg, 2002, 22(4): 504-509.
22. 孙立忠, 刘志刚, 常谦, 等. 主动脉弓替换加支架 “象鼻” 手术治疗 Stanford A 型主动脉夹层. 中华外科杂志, 2004, 42(13): 812-816.
23. Zhang K, Qiu J, Wu J, et al. Long-term outcomes in total arch replacement combined with frozen elephant trunk for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2025, 170(4): 994-1005.
24. Tian DH, Ha H, Joshi Y, et al. Long-term outcomes of the frozen elephant trunk procedure: a systematic review. Ann Cardiothorac Surg, 2020, 9(3): 144-151.
25. Preventza O, Liao JL, Olive JK, et al. Neurologic complications after the frozen elephant trunk procedure: a meta-analysis of more than 3000 patients. J Thorac Cardiovasc Surg, 2020, 160(1): 20-33.
26. Mazzolai L, Teixido-Tura G, Lanzi S, et al. 2024 ESC guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J, 2024, 45(36): 3538-3700.
27. 陈良万, 卢琳, 戴小幅, 等. 单分支支架血管植入技术在急性A型主动脉夹层全弓替换加支架象鼻植入术中的应用. 中华医学杂志, 2011, 91(48): 3435-3437.
28. 孙勇新, 赖颢, 张致琦, 等. Fontus 术中支架在急性A型主动脉夹层中的应用. 中华血管外科杂志, 2018, 3(2): 78-83.
29. Chen LW, Wu XJ, Dai XF, et al. A self-adaptive triple-branched stent graft for arch repair during open type A dissection surgery. J Thorac Cardiovasc Surg, 2015, 149(5): 1278-1283.
30. 严亮亮, 陈银海, 陈良万. 三分支支架血管重建主动脉弓的中远期效果. 学创新, 2017, 14(33): 32-35.
31. Di Bartolomeo R, Pantaleo A, Berretta P, et al. Frozen elephant trunk surgery in acute aortic dissection. J Thorac Cardiovasc Surg, 2015, 149(2 Suppl): S105-S109. doi: 10.1016/j.jtcvs.2014.07.098.
32. 戴路, 邱家伟, 马明星, 等. 应用一体化免缝合带支架人工血管系统治疗主动脉夹层. 中华医学杂志, 2021, 101(12): 872-877.
33. 蒋斌, 刘永春, 郑晓宇, 等. 免缝合技术在主动脉疾病手术中的运用. 血管与腔内血管外科杂志, 2024, 10(5): 623-627.
34. 郑晓宇, 蒋斌, 叶仕高, 等. 免缝合技术治疗急性A型主动脉夹层. 中华胸心血管外科杂志, 2024, 40(8): 459-463.
35. 靳凯悦, 乔环宇, 李晓南, 等. 腋股动脉联合插管在主动脉夹层孙氏手术中的应用. 中华胸心血管外科杂志, 2019, 35(11): 680-683.
36. Takagi H, Umemoto T; ALICE Group. A meta-analysis of total arch replacement with frozen elephant trunk in acute type A aortic dissection. Vasc Endovascular Surg, 2016, 50(1): 33-46.
37. Norton EL, Wu X, Kim KM, et al. Unilateral is comparable to bilateral antegrade cerebral perfusion in acute type A aortic dissection repair. J Thorac Cardiovasc Surg, 2020, 160(3): 617-625.
38. Qiu J, Wu J, Xie E, et al. Surgical management and outcomes of the aortic root in acute type A aortic dissection. Ann Thorac Surg, 2020, 110(1): 136-143.
39. 蒋小浪, 董智慧, 符伟国. 腔内修复治疗Stanford A型主动脉夹层的现状与挑战. 中华外科杂志, 2023, 61(12): 1046-1050.
40. Ferraresi M, Katsarou M, Luigi Molinari AC, et al. Endovascular repair of ascending aortic pathologies in patients unfit for open surgery: case series and literature review. J Vasc Surg Cases Innov Tech, 2024, 10(3): 101455. doi: 10.1016/j.jvscit.2024.101455.
41. Yuan X, Mitsis A, Mozalbat D, et al. Alternative management of proximal aortic dissection: concept and application. Indian J Thorac Cardiovasc Surg, 2022, 38(Suppl 1): 183-192.
42. Shigihara S, Shirakabe A, Okazaki H, et al. Successful treatment of a patient with type-A acute aortic dissection with emergent percutaneous coronary intervention and thoracic endovascular aortic repair under percutaneous cardiopulmonary support: a case report. Eur Heart J Case Rep, 2022, 6(9): ytac344. doi: 10.1093/ehjcr/ytac344. doi: 10.1093/ehjcr/ytac344. doi: 10.1093/ehjcr/ytac344.doi:10.1093/ehjcr/ytac344.
43. Uchida T, Kuroda Y, Yamashita A, et al. Clinical experience of endovascular stent-graft treatment for stanford type A acute aortic dissection. Kyobu Geka, 2019, 72(12): 976-983.
44. Nagashima H, Sugiyama T, Kondo N, et al. Successful application of angioembolization and thoracic endovascular aortic repair (TEVAR) in a retrograde type-A acute aortic dissection with polytrauma. Trauma Case Rep, 2021, 37: 100571. doi: 10.1016/j.tcr.2021.100571.
45. Muetterties CE, Conklin JH, Moser GW, et al. Right axillary artery cannulation for endovascular repair of an acute type A aortic dissection. Innovations (Phila), 2017, 12(2): 140-143.
46. Canaud L, Morishita K, Gandet T, et al. Homemade fenestrated stent-graft for thoracic endovascular aortic repair of zone 2 aortic lesions. J Thorac Cardiovasc Surg, 2018, 155(2): 488-493.
47. Qin J, Zhao Z, Liu G, et al. In situ diode laser fenestration of aortic arch stent grafts during thoracic endovascular aortic repair of Stanford type A aortic dissection. EuroIntervention, 2019, 14(18): e1854-e1860. doi: 10.4244/EIJ-D-18-00710.
48. Ujihira K, Kemmochi R, Matsumoto T, et al. Sandwich technique for endovascular repair of type A aortic dissection following stent graft with an inner branch in the ascending aorta. J Vasc Surg Cases Innov Tech, 2025, 11(2): 101735. doi: 10.1016/j.jvscit.2025.101735.
49. De Freitas S, Rossi MJ, Abramowitz SD, et al. Systematic review and meta-analysis of endovascular interventions for Stanford type A aortic dissection. J Vasc Surg, 2021, 74(5): 1721-1731.
50. Ahmed Y, Houben IB, Figueroa CA, et al. Endovascular ascending aortic repair in type A dissection: a systematic review. J Card Surg, 2021, 36(1): 268-279.
51. 国家心血管病专家委员会血管外科专业委员会. 杂交技术治疗累及弓部主动脉病变的中国专家共识. 中国循环杂志, 2020, 35(2): 124-130.
52. Czerny M, Pacini D, Aboyans V, et al. Current options and recommendations for the use of thoracic endovascular aortic repair in acute and chronic thoracic aortic disease: an expert consensus document of the European Society for Cardiology (ESC) Working Group of Cardiovascular Surgery, the ESC Working Group on Aorta and Peripheral Vascular Diseases, the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg, 2021, 59(1): 65-73.
53. Sule J, Chua CR, Teo C, et al. Hybrid type Ⅱ and frozen elephant trunk in acute Stanford type A aortic dissections. Scand Cardiovasc J, 2022, 56(1): 91-99.
54. Takayama H, Hohri Y, Brinster DR, et al. Open, endovascular or hybrid repair of aortic arch disease: narrative review of diverse strategies with diverse options. Eur J Cardiothorac Surg, 2024, 65(6): ezae179. doi: 10.1093/ejcts/ezae179.

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