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Thoracoabdominal aortic aneurysm is rare but potentially lethal, and its repair continue to present a surgical challenge because of obligate intraoperative visceral, renal, and spinal cord ischemia. In the past, the authors have experienced 4 cases of Crawford Type Ⅲ and Ⅳ thoracoabdominal aortic aneurysm which were treated by a direct surgical approach. The diagnosis was made by CT scan, and aortogram. We repaired the thoracoabdominal aortic aneurysms with Knitted Dacron graft by a single inclusion button that encompasses the origins of the celiac, superior mesenteric, and right renal artery and left renal artery reconstruction with a separate side arm PTFE graft. the visceral ischemia time was less than 45 minutes in 3 operable cases and no paraplegia occurred after thoracoabdominal aortic reconstruction. two cases of Type Ⅳ thoracoabdominal aortic aneurysm with emergent presentation were fatal but elective surgical repairs of Type Ⅲ and Ⅳ thoracoabdominal aortic aneurysm were survived. Appropriate patient selection and prevention of visceral or spinal cord ischemia may be helpful in the repair of Type Ⅲ and Ⅳ thoracoabdominal aortic aneurysm.
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