The first thoracic stent grafts were used in the mid-1990s. They significantly reduced the

perioperative morbidity and mortality of selected patients with thoracic aortic pathology.

However, first and second generation stent-graft technology had significant limitations.

Until recently, endovascular procedures have almost exclusively been restricted to pathology

distal to the left subclavian artery. Recent attention has focussed on endovascular methods to

deal with pathology in the arch of the aorta. This chapter addresses the technical considerations

of stent-grafting in the aortic arch with particular reference to branch endograft technology.