Contemporary operative strategies and technical nuances for open thoracoabdominal aortic aneurysm repair

Open thoracoabdominal aortic aneurysm (TAAA) repair, despite the rise of endovascular approaches, remains a necessary intervention for complex aortic pathologies, particularly in patients with genetically triggered aortopathies or unsuitable anatomy for endovascular grafts. This article describes the surgical techniques and perioperative management protocols. We discuss the importance of patient selection, and intraoperative techniques in open TAAA repair. Our protocol routinely consists of neuromonitoring with motor evoked potentials (MEPs) to detect and address spinal cord ischemia in real-time. The take home lesson from our analysis is that, although endovascular techniques continue to advance and offer less invasive options for TAAA management, open TAAA repair remains a necessary procedure for certain patients. The expertise in open TAAA repair must be maintained and developed in specialized centers to ensure that all patients have access to the most appropriate and effective treatment.