Most complications related to thoracoabdominal aortic reconstruction stem from ischemiainduced injury to the viscera, kidneys, and spinal cord. Pioneers in the treatment of thoracoabdominal aortic aneurysms recognized the danger of producing ischemic damage to these vital organs. In addition to adjunctive methods designed to minimize metabolic demands of the spinal cord during aortic cross-clamping, a variety of extracorporeal techniques have been developed that provide supplemental blood flow to vital end organs during the period of clampinduced ischemia. This article reviews these extracorporeal methods and provides a historical perspective of thoracoabdominal aortic aneurysm repair. In addition, a reengineered technique for thoracoabdominal aortic aneurysm repair is highlighted.
1. DeBakey ME, Creech O Jr, Morris GC Jr: Aneurysm of thoracoabdominal aorta involving the celiac, superior mesenteric and renal arteries. Report of four cases treated by resection and homograft replacement. Ann Surg144:549-573, 1956.
2.
2. Etheredge SN, Yee J, Smith JV, et al: Successful resection of a large aneurysm of the upper abdominal aorta and replacement with homograft. Surgery38:1071-1081, 1955.
3.
3. DeBakey ME, Crawford ES, Garrett HE, et al: Surgical considerations in the treatment of aneurysms of the thoraco-abdominal aorta. Ann Surg162:650-662, 1965.
4.
4. Crawford ES: Thoraco-abdominal and abdominal aortic aneurysms involving renal, superior mesenteric, and celiac arteries. Ann Surg179:763-772, 1974.
5.
5. Crawford ES, Crawford JL. Redo aortic operations. In Crawford ES, Crawford JL, eds: Diseases of the Aorta. Baltimore: Williams & Wilkins, 1984; pp. 317-339.
7. Comerota AJ, White JV: Reducing morbidity of thoracoabdominal aneurysm repair by preliminary axillofemoral bypass. Am J Surg170:218-222, 1995.
8.
8. Taylor PR, Panayiotopoulos YP, Sandison AJ, et al: Temporary left external axillofemoral bypass during repair of a leaking type B aortic dissection. Br J Sutrg84:423-423, 1997.
9.
9. Ballard JL.: Thoracoabdominal. aortic aneurysm repair with sequential visceral perfusi.on: a technical. note. Ann Vasc SUrg13:216-221, 1999.
10.
10. Ballard JL, Abou-Zatnzam AM Jr, Teruya T' H: Type III and IV thoracoabdominal aortic aneurysm repair: results of a trifurcated/two-graft technique. J Vasc Surg Aug;36:211-216, 2002.
11.
11. Ballard JL, Duensing RA: Extracorporeal techniques in thotacoabdominal aortic surgery. In Jacobs M, ed: Seminars in Vascular Surgery. Philadelphia: W.B. Saunders Co.2000; 13:331-339.
13. Twena MF, Ballard JL: Chronic mesenteric ischeinia with aortorenal occlusive disease: repair with trifurcated aorto/mesenteric/renal by-pass and bifurcated aortoiliac bypass. Vasc Surg33:525-528, 1999.
14.
14. leMaire SA, Miller CC, Conklin lID, et al: A new predictive model for adverse outcomes after elective thoracoabdominal aortic aneurysm repair. Ann Thorac Surg2001;71:1233-1238.
15.
15. Martin GIl, O'Hara PJ, Ilertzer NR, et al: Surgical re- pair of aneur sins involving the suprarenral. visceral and lower thoracic aortic segments: early results and late outcome. J Vasc Surg31:851-862, 2000.
16.
16. Cambria RP, Davison JK, Carter C. et al: Epidural cooling for spinal corrd protection diuring thoracoabdoininal aneury-sm repair: a five-year experience. J Vasc Surg31:1093-1102, 2000.
17.
17. Schwartz LB, Belkin M, Donaldson MC, et al: Improvement in results of repair of type IV thoracoabdominal aortic aneurysms. J Vasc SUrg24:74-81, 1996.
18.
18. Cox GS, O'Hara PJ, Hertzer NR, et al: Thoracoab-dornlinal aneurysm repair: a representative experience. J Vasc Surg15:780-788, 1992.
19.
19. Crawford SE, Crawford JL, Safi HJ et al: Thotracoabdominal aortic a neurysms: pt eoperative and intraoperative factors determining immediate and long-term results of operations in 605 patients. J Vasc Sturg3:389-404, 1986.
20.
20. Svensson LG, Crawford ES, Hess KR. et al: Expetience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg17:357-370, 1993.
21.
21. Cambria R, Davison J, Kenneth JK, et al: Thortacoa.bdomin.al aneurysm repait-: pertspectives over a decade with the clamp-and-sew technique. Ann Surg226:294-305. 1997.
22.
22. Dardik A., Perler BA, Roseotrough, Williaams CIM: Anetirysmal expansion of the visceral patch after thoracoabdominal aortic replacement: an arguiment for limiting patch size?J Vase Surg34:405-410, 2001,
23.
23. Gasparis AP, Da Silva MS., Semel L. Visceral patch rupture after repair of thoracoabdominal aortic aneurysm. a case report. Vasc Surg35:491-494, 2001.
