Aneurysms of the thoracoabdominal aorta represent a formidable surgical challenge and their treatment is generally limited to large referral centers such as Duke with expertise in the complex techniques necessary for successful repair.

As with descending thoracic aneurysms, the surgical repair of these lesions carries a risk of spinal cord ischemia, and we use online monitoring of the spinal cord during surgery with somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) to minimize this risk.

In addition, we utilize other adjuncts to further protect the spinal cord, including the use of neuroprotective pharmacologic agents, cerebrospinal fluid drainage, distal aortic perfusion, hypothermia, and intercostal artery re-implantation to maximize positive neurologic outcomes.

Hybrid Surgery

Duke is one of the few centers in the country that offers "hybrid" repairs for thoracoabdominal and aortic arch aneurysms. This technique is a combination of open debranching and endovascular aneurysm exclusion, which eliminates the need for cardiopulmonary bypass and aortic cross-clamp.

The hybrid technique is a safer alternative to open surgery for many patients, making it an option for high-risk patients who cannot undergo conventional open surgery. It's especially suited to patients with other significant health problems or prior open aortic surgery.