Review and current strategy tor thoracoabdominal aortic aneurysm repair

Thoracoabdominal aortic aneurysms (TAAAS) are perrnanent localized dilations of the aorta that involve the celiac axis and extend proximally or distally from this point. Open surgical repair of TAAAS has traditionally involved greater operative risk than repairs of aneurysms in other aortic segments. However, experienced surgical centers now have much lower mortality and morbidity rates for TAAA repair than previously reported. Specific surgical techniques to reduce mortality and prevent end-organ ischemia have emerged, and surgical repair is now widely considered the gold standard, Nevertheless, managing patients during and after TAAA operations remains challenging, and patients in poor health and with extensive aneurysms remain at high risk for postoperative complications. Patients who undergo replacement of the entire thoracoabdominal aorta (extent II) continue to exhibit the highest rates of early death, spinal cord deficit, and renal failure [1]. As the population ages and diagnostic capabilities improve to better identify TAAAS, elderly patients with relatively linrited physiologic reserve are increasingly being referred for treatinent. Thus, the need for continued development and refinement of treatment strategies persists. This presentation will describe our current strategies for open surgical repair of thoracoabdominal aortic aneurysms and additionally provide a briefreview of evolving alternate approaches to open repair.