The purpose of this study was to review retrospectively recent results in 372 patients with thoracoabdominal aneurysm treated by a single surgeon and to identify variables associated with early death, renal failure, and postoperative neurological deficits in patients undergoing thoracoabdominal aortic resection. Between January 11, 1986 and March 1, 1994, 203 males (55%) and 169 females (45%) (mean age 65 years) were treated. Aortic dissection was present in 93 patients (25%). The extent of repair included type I (137 patients), type II (95 patients), type III (73 patients), and type IV (67 patients). The overall 30-day survival rate was 95% (352/372 patients). The overall risk of postoperative neurological deficit was 6.4% (24/372 patients). In 309 patients treated without atriofemoral bypass, paraplegia or paraparesis developed in 23 (7.4%). In 63 patients in whom atriofemoral bypass was utilized, the overall risk of paraplegia or paraparesis was 1.6% (1/63). The use of atriofemoral bypass has had a favorable impact on postoperative neurological complications in selected patients.