Introduction. Surgical treatment of patients with thoracoabdominal aneurysm is still actual problem in cardiovsacular surgery. Material and methods. We have retrospectively analyzed 344 treated patients. Thoracoabdominal aneurysms Crawford I—IV and descending aortic aneurysms were diagnosed in 186 (54,1%) and 158 (45,9%) patients respectively. Results. For the follow-up period surgical mortality in case of thoracoabdominal aneurysms has been decreased to 8.9%. According to our opinion major predictors of adverse events are extended reconstruction (р=0.0086), intraoperative blood loss over 4.5 liters (р=0.003) and postoperative renal failure (р=0.0005). 2-fold decrease of blood loss was observed if «bag handle» technique introduced by us was applied (р=0.0042). Organs protection is provided by using of active selective blood perfusion as well as «Custodiol» infusion. Herewith safe period of absolute ischemia ranges from 30 to 50 minutes in normothermia. Development of «hybrid» methods significantly reduced incidence of complications. We consider that patients with thoracoabdominal aneurysm and dissection are candidates for «hybrid treatment».