The natural prognosis of thoracic-abdominal aortic aneurysm (TAAA) is poor. Multiple visceral arteries are often involved, which brings challenges to safe surgical treatment. The current surgical treatment of TAAA include: open repair, hybrid surgery and total endovascular repair. Open repair is the standard approach with satisfactory long-term efficacy, but it is also a surgically complex and highly invasive procedure with high incidence of complications. Hybrid procedure and endovascular repair developed in recent years have shown their advantages, but there are still shortcomings. The surgical treatment options for TAAA should follow the principle of individualization. Multidisciplinary collaboration can minimize the risk of surgery and maintain long-term durable outcomes for TAAA patients.