We present the outcome of surgical management for thoracoabdominal aneurysms in 27 patients during the past 22 years. Ischemia of visceral organs was successfully prevented by axillo-femoral temporary bypass using a 10mm PTFE graft with an 8mm branch for main visceral vessels and partial extracorporeal circulation perfusing visceral organs. No other significant problems were encountered. Paraplegia occurred in 5 patients (18.5%). Three of them had received reconstruction of the intercostal arteries. Patients treated by spinal fluid drainage developed no paraplegia. The Crawford inclusion and Piehler bypass techniques were useful in reconstructing the main visceral vessels. Two patients died of ruptured proximally anastomosed thoracic aorta after a thromboexclusion technique. Early death occurred in three patients and late death in one.

Between 1961 and 1994, 121 patients our hospital were treated by conservative and surgical therapy for acute (67 patients) and chronic (54 patients) type B aortic dissection. Among the acute type B aortic dissections, two patients died before operation and 4 patients underwent surgical treatment in the acute phase. The false channel was occluded due to thrombosis in 30 patients. 9 in 31 patients with patent false channels required surgical therapy in the chronic phase. 46 of 54 patients with chronic type B aortic dissection underwent surgical treatment and 9 other patients were not operated on because of the false channel was not enlarged, nearly thrombosed type and refusal to operate. The long-term survival rate appeared to be better in cases acute closing aortic dissection than in cases of aortic dissection with patent false channels. Among the 54 patients who required surgical treatment in the chronic phase, there were eight early deaths (13.3%). Among chronic phase surgical cases, the long term survival rate appeared to be similar to that in type B aortic dissections treated by conservative therapy. Therefore, we consider that type B aortic dissections with acutely thrombotic false channels should be treated by medical therapy, while type B aortic dissection with patent false channel should be treated surgical treatment in the subacute phase or early chronic phase.