From July 1985 to July 1989, Loma Linda University Medical Center evaluated 46 thoracoabdominal aortic aneurysms (TAAAs). Forty patients were taken to surgery--18 (45%) were operated on an emergency basis for reasons including rupture (12 patients, 30%), dissection (5 patients, 12.5%), and severe pain (1 patient). The overall mortality for all operated patients was five (12.5%-17% for emergency surgery versus 9% for elective surgery). Nonfatal complications occurred in 40 per cent of patients (16). The overall incidence of paraplegia was 10 per cent (4/40), emergency patients 17 per cent (3/18) versus elective patients 4.5 per cent (1/22). Careful preoperative evaluation, standardization of operative technique, and good postoperative management have improved the outlook for these patients who otherwise would progress to eventual rupture and death. Because mortality and morbidity are substantially reduced in elective patients, we recommend that all patients with TAAAs be evaluated for surgery as soon as diagnosis is made.