Seventeen patients with thoracoabdominal aneurysms, including 5 rupturedaneurysms, were operated upon using a left diaphragm-splittingthoracoabdominal incision and the retroperitoneal route. A temporary shuntwas used in 13 patients, femorofemoral perfusion in 1 and cold perfusioncooling of the kidneys in 3 patients. The step-by-step reattachmenttechnique into ready-made limbs or holes in the Dacron graft ensured thatvisceral and renal ischaemic times remained within acceptable limits. Themean renal and proximal clamping times were 44 and 77 min, respectively.One patient with a ruptured aneurysm (6%) died of diffuse bleeding. Theothers recovered without paraplegic, renal or other severe complications.During the follow-up period, mean 44 months and range 10-116 months, 3patients died of lung cancer and 2 of coronary disease giving a latemortality of 29%. The remaining 11 patients are alive and well. Thecumulative 2- and 5-year survival is 87% and 62% respectively. The patencyrate of the grafts was 100% and that of the 30 individually revascularisedarteries 80%. We recommend elective surgery for thoracoabdominal aneurysmsusing a temporary shunt or cold perfusion cooling of the kidneys as aprotective measure against perioperative ischaemia.