A pragmatic approach in aiming to do the right things in patients with thoracic aortic pathology involving the aortic arch

The last decade has overwhelmed the surgical community with options regarding the treatment of patients with thoracic aortic pathology involving the aortic arch as to a point where supply exceeds demand. Consequently, surgeons are confronted with a new challenge being weighing conventional surgery to several other options where some are good, some are bad and some are ugly. This manuscript is meant to serve as a pragmatic companion for the interested physician in accompanying patients with thoracic aortic disease through the natural history of the disease, to indicate the right time for treatment with adequate risk stratification, to balance options and to do the right things when advancing to treatment.