Perfusion techniques for thoracoabdominal aortic aneurysms

The surgical treatment of thoracoabdominal aortic aneurysms (TAAA) is a complex procedure and requires appropriate planning. The TAAAs are subdivided according to the Crawford classification (types I-V). Type II TAAA requires the most extensive intervention and accordingly shows the highest postoperative morbidity and mortality. The perfusion strategy for sufficient supply of the spinal cord and visceral organs is crucial during the operative treatment of TAAAs. Distal arterial perfusion, selective visceral perfusion and the additive protective measures with cerebrospinal fluid drainage and hemodynamic management for early re-establishment of pulsatile arterial flow are important components for a good outcome. The techniques of extracorporeal circulation with a heart-lung machine or left heart bypass with the advantages and disadvantages are discussed. The options for visceral organ perfusion are presented.