Best surgical option for thoracoabdominal aneurysm repair - the hybrid approach.

Abstract

Thoracoabdominal aortic aneurysms (TAAAs), defined by the involvement of the visceral vessel origins, tend to present in an elderly population, often with extensive co-morbidities. They may be identified incidentally or present late with symptoms secondary to aneurysm expansion. Untreated, the mortality from aneurysm rupture is high (1). Since the first reported case of surgical reconstruction by Etheredge et al. in 1955 (2) and subsequent modifications to the original technique, conventional open TAAA repair became the mainstay of treatment for the next 40 years. Access to the aorta is gained through a thoraco-abdominal incision dictated by TAAA extent. The original clamp and sew technique with revascularization of major aortic branches has been modified over the years and now may involve cardiopulmonary bypass with hypothermic circulatory arrest, single-lung ventilation, cerebrospinal fluid drainage, and epidural cooling, resulting in long operative times, significant blood loss, volume shifts, and prolonged recovery times.