TECHNICAL ADVANCES IN THE SURGICAL-MANAGE MENT OF THORACOABDOMINAL AORTIC-ANEURYSMS

Thoracoabdominal aortic aneurysmectomy ranks among the major cardiovas cular surgical procedures. During the last two decades perioperative r esults have improved to the point that surgery should be discussed in the vast majority of patients seen with a thoracoabdominal aortic aneu rysm. This progress is largely attributable to a variety of technical improvements including : aortic reconstruction using the graft inclusi on technique, usually with direct reattachment of aortic branches to t he prosthetic graft; distal aortic perfusion; selective use of deep hy pothermic circulatory arrest in anatomically complex situations; preop erative visualization of arterial blood supply to the spinal cord usin g selective arteriography of intercostal and lumbar arteries. Current perioperative mortality is around 10 % whereas the spinal cord complic ation rate is between 5 % and 20 % according to clinical and anatomica l conditions. Future efforts should concentrate on the prevention of s pinal cord complications.