In 2010, more than 3,000 cases of endoluminal treatment of thoracic aortic dilatation diseases were completed in China, especially the number of cases of endoluminal treatment of aortic coarctation ranked first in the world. This achievement, like the technique of amputation reimplantation, has once again drawn the attention of Chinese vascular surgeons around the world. Looking back to 1998 when the first case of intracavitary isolation of aortic coarctation in China was completed at Changhai Hospital, in just over 10 years, the units carrying out this technology have spread across the country, treating diseases ranging from aortic coarctation to true aneurysms, pseudoaneurysms and transmural ulcers, and the range of lesions that can be treated has developed from being limited to the descending aorta to the aortic arch and ascending aorta, such progress is indeed something we should be proud of. More importantly, in China today, the majority of vascular surgeons and thoracic surgeons have reached a consensus that the endoluminal technique is minimally invasive and safe, and that endoluminal treatment should be preferred for dilated lesions of the thoracic aorta that can be treated with the endoluminal technique. In order to better popularize this technology, this article summarizes the current key techniques in the treatment of dilated aortic lesions. The “hybrid” technique, also known as the aortic arch debranching technique, refers to the use of various extra-anatomic bypasses to preserve the blood supply to the aortic arch while using endoluminal grafts to repair lesions in the aortic arch. The “hybrid” technique is also known as aortic arch debranching. The “hybrid” procedure has a wide range of applicability, as aortic lesions, regardless of their location in the aortic arch, can be diverted through the supra-arch arteries to maintain the blood supply to the brain. The specific diversion methods are left vertebral artery transposition, left common carotid artery-left subclavian artery or left vertebral artery bypass, right common carotid artery-left common carotid artery-left subclavian artery serial bypass, ascending aorta-right common carotid artery-left subclavian artery bypass, and left common carotid artery-left subclavian artery bypass. left common carotid artery-left subclavian artery sequence bypass, etc. Left vertebral artery transposition means that after adequate freeing of the left common carotid artery and the first segment of the left vertebral artery, the beginning of the left vertebral artery is transected, the proximal end is ligated, and then the distal end of the left vertebral artery is anastomosed end-to-end with the left common carotid artery. In this way, the left vertebral artery is replaced by the left subclavian artery for blood supply, and the opening of the left subclavian artery can be safely closed during surgery. The left common carotid artery-left subclavian artery bypass is also a common hybridization procedure when the endothelial rupture of the aortic coarctation is located near the opening of the left subclavian artery. The procedure can be done within a single transverse incision in the left supraclavicular fossa, which allows the use of a shorter graft, or the anastomosis between the artificial vessel and the left common carotid artery can be made close to the bifurcation of the common carotid artery, which reduces shunting of the common carotid artery blood flow but requires two incisions. There are also many nuances to this procedure, starting with the fact that the proximal left subclavian artery can be ligated or unligated. The advantage of ligation is that it creates a greater pressure gradient at both ends of the bridge vessel, which ensures patency of the bridge vessel if the procedure is staged, and the ligated proximal left subclavian artery prevents endoleaks due to reflux through the subclavian artery opening; the disadvantage is that it can no longer be located intraoperatively through the catheter left in the left subclavian artery. The advantages and disadvantages of keeping the left subclavian artery patent are reversed, as a large spring ring can be used to embolize the opening of the left subclavian artery to eliminate endoleaks if they result from keeping the left subclavian artery patent. A derivative of the left common carotid artery-left subclavian artery bypass is the left subclavian artery transposition, in which the left subclavian artery is transected directly before the emanating vertebral artery, ligated proximally, and anastomosed distally to the left common carotid artery. The advantages of this approach are that it avoids the use of bypass vessels and there is only one anastomosis, which shortens the operative time. However, the proximal end of the left subclavian artery is relatively fixed due to the numerous branches of the vertebral artery, internal mammary artery, and metacervical trunk, making this segment of the subclavian artery relatively fixed, and sometimes the tension of the direct anastomosis with the common carotid artery is too great. For patients with lesions involving the left common carotid artery, intraoperative grafts need to close the left common carotid artery, the left subclavian artery and the intimal rupture of the aortic coarctation together in order to achieve complete isolation of the aortic coarctation. This is where a right common carotid artery-left common carotid artery-left subclavian artery serial bypass can protect the blood supply to the brain. After completion of the right common carotid artery-left common carotid artery artificial vessel bypass, a transverse incision is made in the left supraclavicular fossa to reveal the left subclavian artery and left common carotid artery, and the left common carotid artery is transected, ligated proximally and anastomosed distally to the left subclavian artery end to end. This still allows intraoperative imaging and localization through the left subclavian artery with an indwelling catheter. If there is an endoleak originating from the left subclavian artery after graft release, the endoleak can be eliminated by embolization of the left subclavian artery opening with a spring coil. If the aortic lesion involves the opening of the innominate trunk artery, all three vessels on the arch need to be closed, which requires a serial ascending aorta-right common carotid artery-left common carotid artery-left subclavian artery bypass. In the operation, the bilateral common carotid arteries and the left subclavian artery are firstly freed through the neck incision, then the chest is opened medially, the anterior lateral wall of the ascending aortic artery is freed in the pericardium, and the lateral wall blocks the ascending aorta; a 14-7 mm bifurcated polyester artificial vessel is taken, and the proximal end of the artificial vessel is firstly anastomosed with the ascending aorta end to end and marked with a titanium clip around the anastomosis; then the two branches of the artificial vessel are separately anastomosed with the bilateral common carotid arteries end to end or Finally, the left common carotid artery is bypassed with the left subclavian artery or the proximal left common carotid artery is transposed with the left subclavian artery. 2 “Opening technique” The “opening” technique can be divided into the graft preopening technique and the in situ puncture opening technique. 2.1　The graft preopening technique consists of two methods: the apical semicircular opening or “slotting” of the graft and the central circular opening of the graft. The apical semicircular graft opening is used in cases where the entrapment fissure is located on the medial border of the aortic arch, opposite the opening of the left subclavian artery. The graft is released in vitro before being introduced into the body, and the overlying portion of the graft to be released on the greater curvature of the aortic arch is trimmed with a semicircular notch that is appropriate for the size of the left subclavian artery opening. The left and right sides of the trimmed window and the proximal and distal ends of the window are marked with titanium clips to accurately position the window under DSA to overlap the left subclavian artery opening intraoperatively. The grafted circular window is suitable for patients with a clamping rupture located in the aortic arch, the patient has a bovine aortic arch, and the right vertebral artery is dominant, only the common unnamed artery and the left common carotid artery opening need to be preserved when isolating the aortic clamping rupture on the arch to preserve the blood supply to the brain. The indications for graft in situ opening are similar to those for graft semicircular opening, but the intraoperative endoluminal vascular surgery technique is more demanding. The method is to release the graft over the left subclavian artery to cover the opening of the left subclavian artery, then use a guide wire stiff tip to penetrate the graft polyester film at the opening of the left subclavian artery via a catheter reserved in the left brachial artery, guide the catheter through the graft into the aortic arch, exchange the guide wire, guide the cutting balloon to dilate the opening of the graft film, then release a self-expanding stent with a diameter equivalent to that of the left subclavian artery after The “chimney” technique involves pre-preserving the guidewire or catheter from the left subclavian artery or common carotid artery to the ascending aorta and using a common aortic endoluminal graft to first cover the superior branch vessels of the arch. A bare stent or overlapping stent is then released along the reserved guidewire between the covered branch vessel and the proximal aorta, leaving a channel between the aortic wall and the endoluminal graft to ensure blood flow to the covered branch vessel. The original intention of the “chimney” technique was to prevent endoleaks by extending the aortic anchorage zone proximally, but the stent used as a “chimney” increases the gap between the aortic graft and the aortic wall, increasing the potential for endoleaks.4 Branched Graft Technique However, some scholars at home and abroad have successfully completed a small number of cases using homemade or custom-made grafts. With the development of intracavitary isolation grafts in the aorta, branch grafts may be the direction of development for the treatment of arch lesions. The branch graft technique can be further divided into two categories: preservation of the aorta with a branch graft and complete luminal reconstruction of the aortic arch.4.1 Preservation of the aorta with a branch graft Branch graft Preservation of the aorta with a branch graft The branch graft preserves the aorta with a short graft in the aortic arch with a branch graft in the main body with a branch graft in the aorta with a branch graft in the aorta and an accessory graft in the aorta with a branch graft in the aorta. a long aortic graft attached to the main body within the aortic arch. A cervical vascular bypass is performed, followed by introduction of the graft body via the right common carotid artery, with the graft body released within the aortic arch and the branch graft secured within the innominate trunk; then, the aortic long graft is introduced via the femoral artery and released within the aortic arch in connection with the graft body.4.2 Complete branch graft technique for reconstruction of the aortic archThe complete branch graft technique for reconstruction of the aortic arch involves the use of an aortic graft with three A complex catheterization technique is required to introduce the main body of the graft from the femoral artery and then introduce the three branches into the innominate trunk artery, the left common carotid artery, and the left subclavian artery for release and fixation. The grafts need to be customized based on detailed preoperative supra-arch vascular measurements.