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In thoracoabdominal aortic aneurysm (TAAA) repair, postoperative respiratory complication is a major problem. TAAA repair was performed in a 75-year-old man. The computed tomography showed a TAAA (Crawford type Ⅳ) with shaggy descending thoracic aorta. Stomach and small intestine were compressed by the TAAA with resultant appetite loss. And reduced respiratory function was observed. In such a case thoracotomy is usually required for operation. However, we applied the extra pleural dissection without thoracotomy, and the diaphragm and intercostal muscles were preserved. Using the selective abdominal organ perfusion, graft replacement was performed between iliac arteries and descending aorta. The postoperative course was uneventful, and respiratory function was preserved.
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