Physician-modified four-fenestration endograft: The first case in Türkiye.

Endovascular repair has become a standardized approach for aortic diseases, but visceral branch involvement presents major technical challenges. Fenestrated repair allows aneurysm exclusion while maintaining organ perfusion, though custom-made devices are costly and often unavailable in urgent settings. We report the first physician-modified four-fenestration endograft (PMEG) procedure performed in Türkiye for a contained rupture of the visceral aorta. All four visceral branches were successfully revascularized with full exclusion of the aneurysm. The patient had an uneventful recovery, and one-month control computed tomography angiography confirmed complete graft integrity and patency of all visceral branches.