Endovascular treatment of thoracic aorta (TEVAR) often requires supra-aortic arterial trunks debranching to provide an acceptable proximal landing zone. To facilitate TEVAR procedures involving landing zones 1 to 3, we propose a systematic 4-step strategy with 1) a primary surgical cervical exposure of the supra-aortic trunks; 2) insertion through this access of a 5 Fr introducer in the first non-covered supra-aortic trunk to delineate precisely the landing zone; 3) followed by deployment of the thoracic endograft through one femoral access; 4) immediate completion of the surgical debranching, i.e. transposition or bypass.
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