title: Progress and future challenges in thoracoabdominal aortic aneurysm management.
abstract: BACKGROUND
  Postoperative paraplegia and paraparesis have been the scourge of thoracoabdominal aortic repair since the inception of the procedure.
  
  
  RESULTS
  In our experience with more than 1,250 cases in 15 years, we have developed adjunctive strategies that have pushed neurologic deficit rates down from over 30% percent in the most extensive cases to less than 2% overall in the modern era. The dramatic reductions in risk reported by ourselves and others have led to recent complacency regarding the importance of this complication, and widening use of endovascular technologies raises the potential specter of a return to suboptimal results.
  
  
  CONCLUSIONS
  Utmost care is required in the vetting of these new technologies to prevent regression of the hard-won excellent results obtainable by open repair. Postoperative renal failure, in stark contrast to neurologic deficit, has remained resistant to every treatment that has been described in the literature. The fact that we haven't learned to treat it means that we don't understand the mechanisms behind it, and this problem is worthy of a major focused discovery and management effort. We have recently begun a multi-pronged research program to discover basic mechanisms of renal injury so that appropriate and effective treatments can be discovered.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, The University of Texas at Houston Medical School, Memorial Hermann Heart and Vascular Institute, 6410 Fannin, Suite 450, Houston, Texas 77030, USA. safi.correspond@uth.tmc.edu
authors.forename: Hazim J
authors.initials: HJ
authors.lastname: Safi
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Estrera
authors.forename: Ali
authors.initials: A
authors.lastname: Azizzadeh
authors.forename: Sheila
authors.initials: S
authors.lastname: Coogan
authors.forename: Charles C
authors.initials: CC
authors.lastname: Miller
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020335:Paraparesis / Q000209:etiology / Q000517:prevention & control*; D010264:Paraplegia / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods / Q000639:trends