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.