Tear of joy or sorrow: endovascular stent grafting for thoracoabdominal aorta.

Surgery for thoracoabdominal aorta actually began before the era of cardiopulmonary bypass. In the mid-1950s, Ellis et al., Etheredge et al., and DeBakey et al. opened a field of surgery for throacoabdominal aorta using allograft. In 1965, DeBakey reported their results as 26% mortality in 42 patients with thoracoabdominal aortic aneurysms who underwent the extra-anatomical reconstruction of the thoracoabdominal aorta without using a cardiopulmonary bypass. Crawford et al. modified and simplified the operation, such as “in situ” reconstruction of the thoracoabdominal aorta using the inclusion technique, reducing hospital mortality to 8% by 1978. After using a simple proximal aortic clamping, they classified the thoracoabdominal aortic aneurysm into four categories according to its extension and demonstrated that early mortality and postoperative neurological deficit were 10.7% and 28.3%, especially, in extent II aneurysm. The progress of thoracoabdominal aortic surgery has mainly been achieved by the sons of Crawford. Svensson et al. demonstrated the efficacy of intraoperative monitoring of the cord function using motoror sensory-evoked potentials and intrathecal papaverine to prevent cord ischemia. Coselli et al. reported an enormous surgical series of thoracoabdominal aorta with an exceptionally good result. Safi et al. showed a greater improvement of surgical results for thoracoabdominal aorta using the adjunct, such as the distal bypass, cerebrospinal fluid drainage, and crystalloid fluid infusion into the kidneys. The European followers also reported excellent clinical results of the thoracoabdominal aortic disease. We owe much of our knowledge regarding aortic aneurysm to our “sitting on the shoulders” of predecessors. However, surgery for thoracoabdominal aorta still remains a mountain to be conquered in the field of cardiovascular surgery. The incidence of postoperative spinal cord complications is reTear of Joy or Sorrow: Endovascular Stent Grafting for Thoracoabdominal Aorta