Strategies for accurate endograft placement in the proximal thoracic aorta.

Accurate positioning of thoracic endografts in the aortic arch and the proximal descending thoracic aorta can be difficult because of the tortuous arch anatomy and the hemodynamic forces therein. Adjunctive measures are necessary and include pharmacological interventions as well as rapid ventricular pacing and right-atrial-inflow occlusion. Endograft design advances have also been instrumental in increasing the applicability of this technology to the arch. These adjunctive measures are subsequently described.