Conventional Surgery in Type IV Thoracoabdominal Aortic Aneurysm

Type IV thoracoabdominal aortic aneurysms (TAAAs) affect the aorta between the diaphragm and aortic bifurcation (Fig. 1). For technical reasons, the aneurysms affecting only the part of aorta from which visceral arteries arise are also categorized as type IV. The level of difficulty of surgical treatment for type IV TAAAs lies between that of type II, which involve descending thoracic and abdominal aorta, and that of the most frequent aneurysm of the aorta: infra renal aortic aneurysm. Like all other TAAAs, the most frequent complication of surgical repair of type IV aneurysms is renal and visceral ischemia. However the risks of pulmonary, spinal and hemorrhagic complications are also important. Except for a few specific cases, surgical repair is carried out in a conventional way according to the technical method explained by Crawford in 1974. Endovascular techniques require specialized teams and will not be addressed in this chapter.