Thoracoabdominal aneurysm repair

Aneurysms that extend from the descending thoracic aorta into the abdomen a nd also those that involve the visceral segments of the upper abdominal aor ta are traditionally classified as thoracoabdominal. Besides the surgical e xposure difficulties associated with repair of these aneurysms, the tempora ry interruption of renal, splanchnic, and perhaps even spinal cord flow int roduces a number of potential complications that makes surgical repair of t hese aneurysms a daunting task. The exact incidence of thoracoabdominal aneurysms is unknown, but populatio n studies suggest a prevalence at least a log fold less than the more commo n infrarenal abdominal aortic aneurysm, The poor prognosis of nonsurgically treated aneurysmal disease of the descending thoracic and abdominal aortas has been reasonably well established. Few patients with thoracoabdominal a neurysms survive beyond five years as a result of not only aneurysm rupture but also death from advanced co-morbid medical disease. Since the first successful report of thoracoabdominal aneurysm repair over 40 years ago, a number of remarkable contributions have been made in the fi eld. These advances have led to a significant decline in operative mortalit y as well as procedure related morbidity, Spinal cord ischemia remains a perplexing and devastating complication foll owing thoracoabdominal aneurysm repair. A number of surgical adjuncts have been developed over the years to reduce the incidence of cord ischemic comp lications, yet a great deal of controversy still exists with regards to the optimal protective strategy. A description of the incidence, natural history, and classification of thor acoabdominal aneurysms, along with associated repair techniques centered on reducing spinal cord ischemic complications will form the basis for this r eview. (C) 1999 The International Society for Cardiovascular Surgery. Publi shed by Elsevier Science Ltd. All rights reserved.