Summary and Conclusions

There have been significant advances in the management of patients with thoracoabdominal aortic aneurysms.

Improved understanding of the natural history of the disease and patient selection improves patient outcome and avoids futile operations. This is particularly true in emergency surgery.

Many of the adjuvant techniques to protect against visceral, renal and spinal cord ischaemia and reperfusion are now well established and allow specialist centres to report impressive results.

The advent of endovascular technologies, both our current "hybrid" approach and future branched stent grafts, suggest that the short-term outcome for these patients may soon be improved further.

Fig. 4.1.5 Completed visceral hybrid procedure showing the stented aorta and retrograde grafts to the coeliac, superior mes-enteric and renal arteries

• In the immediate future we will continue to perform a hybrid procedure in preference to an open repair in appropriate cases.

• It is gratifying that we are now considering the quality of life after these major and complex vascular procedures when once all that was considered was survival, even if that meant a patient suffering the catastrophic complication of paraplegia.

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Essentials of Human Physiology

Essentials of Human Physiology

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