Innovations in the endovascular treatment of complex aortic pathologies

Aortic arch and thoracoabdominal pathologies remain associated with high morbidity and mortality when treated with open surgical repair. Over the past two decades, endovascular techniques have progressively expanded into these complex anatomical regions. This cumulative dissertation synthesizes clinical and technical contributions aimed at improving the safety, applicability, and durability of complex endovascular aortic repair. The portfolio integrates single-center studies, multicenter registry analyses, systematic reviews, and technical feasibility reports. In the aortic arch, it evaluates hybrid debranching strategies, fenestrated and branched thoracic endovascular aortic repair (TEVAR), and refined techniques to reduce neurological complications. Particular focus is placed on left subclavian artery management and the feasibility of endovascular repair in patients with mechanical aortic valves. In the thoracoabdominal aorta, the work examines custom-made, off-the-shelf, and physician-modified endografts, as well as the durability of bridging stents and renal target vessel preservation. The findings demonstrate high technical success rates, acceptable perioperative risk, and improving mid-term durability across complex anatomies. Collectively, these studies illustrate the evolution of endovascular aortic surgery into a viable and increasingly standardized treatment strategy for complex aortic disease, contributing to expanded patient eligibility and refined complication management.