title: Management of thoracoabdominal aneurysm type IV.
abstract: BACKGROUND
  Thoracoabdominal aneurysm type IV (TAA IV) represents only a minority of aortic aneurysms, but as it is an entirely abdominally located aneurysm, vascular surgeons are likely to see such aneurysms in their practice. The current surgical management of TAA IV is reviewed.
  
  
  METHODS
  A PubMed/Medline-literature search for TAA IV.
  
  
  CONCLUSIONS
  A detailed preoperative evaluation to determine the rupture and operative risk is required. A threshold size of 5.5-6 cm is recommended for elective repair of TAA IV, which then is adjusted for age and other risk factors. Operative simplicity with the clamp and sew approach to obtain a short aortic cross-clamp time seems to have most support in the literature. The necessity of adjunct treatment to prevent visceral and spinal cord ischemia seems to be needed rarely. Uncomplicated repair has a minimal risk of neurological injury and a low risk of renal failure requiring dialysis in patients without preoperative renal dysfunction or renal artery stenosis. The role of endovascular repair of these aneurysms remains to be established.
authors.affiliation: Department of Vascular Surgery, Karolinska University Hospital, Stockholm, 171 76 Stockholm, Sweden. carl.wahlgren@kus.se
authors.forename: C-M
authors.initials: CM
authors.lastname: Wahlgren
authors.forename: E
authors.initials: E
authors.lastname: Wahlberg
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000503:physiopathology / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D051437:Renal Insufficiency / Q000517:prevention & control; D013119:Spinal Cord Injuries / Q000517:prevention & control; D014656:Vascular Surgical Procedures; D014781:Viscera / Q000503:physiopathology