Introduction
Thoracoabdominal aortic aneurysm (TAAA) repair remains a great challenge. Some serious complications such as paraplegia, gastrointestinal complications and acute kidney injury are still unavoidable1,2. Since the first surgical procedure of TAAA was first reported by Debakey in 19653, several approaches have been applied to improve clinical outcome including the clamp-and-sew technique and the use of distal aortic perfusion. The maneuver of distal perfusion includes passive bypass without extracorporeal circulation and extracorporeal circulatory assistance including left heart bypass (LHB), partial cardiopulmonary bypass and hypothermic circulation arrest. Cerebrospinal fluid drainage (CSFD), renal perfusion and selective visceral perfusion (SVP) were also applied in TAAA repair to prevent visceral, renal and spinal cord ischemia1. In this report, we applied sequential aortic cross clamp-and-sew under normothermia to perform the TAAA repair, with the use of CSFD, renal perfusion and SVP. And the case in our report was also the TAAA with the largest diameter that had ever received successful surgical intervention to date. The study was approved by the institutional review board of Fuwai Hospital. A waiver of informed consent was granted due to the design of the study.