Aortic Repair in Landing Zone 2: From Chimney Technique to Branched Graft

In the era of thoracic stent grafting, the incidence ofextrathoracic debranching procedures has markedly in-creased. Aortic pathologies such as degenerative aneurysm,dissection, intramural hematoma, or penetrating aortic ul-cer can now be treated with lower morbidity and mor-tality rates compared to traditional open arch debranch-ing, which required median sternotomy and aortic cross-clamping. The development of thoracic endovascular aorticrepair (TEVAR) has therefore revolutionized the treatmentof complex thoracic lesions, reducing perioperative traumaand improving clinical outcomes. Nevertheless, when theproximal sealing zone extends into the aortic arch, partic-ularly in zone 2 according to Ishimaru’s classification, theinvolvement of the left subclavian artery (LSA) becomes acritical issue.