Treatment of Complex Thoracoabdominal Aortic Disease.

Thoracoabdominal aortic aneurysms are increasing in incidence. Rupture is associated with a high rate of morbidity and mortality. The historic gold standard of open repair can be performed with low rates of complications at centers of excellence. However, these results are not universally achievable, with significantly higher rates of mortality reported from statewide studies. With the advent of endovascular therapy, techniques to mitigate the physiologic stress of open surgery have been developed. Hybrid open/endovascular operations are being undertaken with total visceral debranching followed by endografting. Totally endovascular procedures are now being performed using fenestrated, branched, and parallel endografts.