A physician-modified endograft for intercostal arteries preservation and its role as an endovascular strategy in chronic aortic dissection.

Treatment of thoracoabdominal aortic aneurysm post aortic dissection is challenging and carries a significant risk of spinal cord ischemia. Open surgery allows reimplantation of intercostal arteries (ICAs), whereas conventional endovascular treatment cannot. We report a 46-year-old patient treated with a physician-modified endograft with posterior fenestrations to preserve perfusion of ICAs. The device was deployed in the true lumen to maintain sealing, with a large fenestration aligned to the target ICAs. Two custom-made false lumen endoprostheses were also placed in the false lumen. The postoperative course was uneventful, and 1-year imaging showed complete false lumen exclusion and positive aortic remodeling.