Book excerpt: This book shows how new technologies and technical skills together with deeper understanding of pathophysiology of visceral and renal ischemia have contributed to significant improvements in the clinical outcomes in patients undergoing complex aortic repair involving splanchnic arteries. In recent years, aortic repair has expanded its borders, focusing more and more on the particularly challenging segments from which critical branches originate. Optimal results in this area are obtained through a multidisciplinary approach based on crucial elements such as sophisticated imaging techniques, advanced anesthesiological and pharmacological strategies, as well as updated surgical techniques and devices able to reduce ischemic injuries. The book presents problems tackled from different perspectives, by analyzing the main technical aspects of the surgical technique but also functional and metabolic issues. It also discusses concepts such as ischemic preconditioning and ischemia-reperfusion mechanisms, as well as innovative investigational approaches. In the “endovascular era”, it highlights the most recent updates in complex endovascular repair involving renal and visceral arteries, providing both practical tips and tricks and outcomes analyses. The volume also addresses specific, rarely reported problems in vascular surgery, including issues in renal transplant, oncologic surgery with involvement of splanchnic arteries and of the vena cava, and use of the deep veins in aortic surgery. This volume represents a powerful tool for both young and experienced operators who wish to approach the complex aortic pathology either by open surgery or through endovascular methods.”