title: Debate regarding the best surgical option for type IV thoracoabdominal aortic aneurysms.
abstract: Conventional open surgical repair, endovascular treatment, and the hybrid technique constitute the three treatment options for patients with type IV thoracoabdominal aortic aneurysms (TAAAs). Treatment is advocated to prevent rupture but yields significant risk for spinal cord ischemia, cardiovascular, and renal and respiratory complications, including death. Refinements in open surgical techniques and branched endovascular graft repair together with the development of hybrid techniques have been applied to the treatment of type IV-TAAAs to decrease the risk of these complications. However, much of the evidence of the argument is circumstantial. Large experiences are limited to a few centers worldwide with inherent disparity between patient groups and several limitations to the construction of a prospective randomized trial. This controversial subject is now open to discussion, and our debaters have been given the challenge to clarify the evidence to justify their preferred option for repair of type IV-TAAAs.
authors: Regional Vascular Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom. michael.jenkins@imperial.nhs.uk
authors: Michael P
authors: MP
authors: Jenkins
authors: Stéphan
authors: S
authors: Haulon
authors: Roy K
authors: RK
authors: Greenberg
authors: Thomas L
authors: TL
authors: Forbes
mesh_terms: D017545:Aortic Aneurysm, Thoracic / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D019317:Evidence-Based Medicine; D006801:Humans; D018579:Patient Selection; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome