[How to Approach for Descending Thoracic Aneurysm and Thoracoabdominal Aortic Aneurysm]

Good exposure of aortic lesions is very important to perform the surgery for descending thoracic aneurysm (DTA) and thoracoabdominal aortic aneurysm (TAAA). The patient is positioned in the right lateral decubitus position with the shoulders at 90°, and the hips flexed to 45°. A left thoracoabdominal skin incision is made in the 6th intercostal space beginning at the posterior axillary fold, and is extended through the costal cartilage and obliquely across the abdomen. The left chest cavity is exposed through the 6th intercostal space, and the costal arch is divided, then the descending thoracic aorta is exposed. The abdominal aorta is exposed through the retroperitoneal cavity. The dissection of diaphragm is carried out to expose the aortic hiatus. When the diaphragm is cut to get better exposure, it is circumferentially cut, at the muscle edge of approximately 2 cm. Then the aortic lesion of extent Ⅱ TAAA, which is all of thoracoabdominal aorta, can be exposed. Lung and abdominal organs should be retracted gently to avoid the damage of them.