A zone zero physician-modified endograft for blunt thoracic aortic injury.

Blunt thoracic aortic injury (BTAI) requires urgent treatment, often limiting options in patients with unconventional anatomies. We report the case of a 61-year-old man with grade III BTAI adjacent to a dominant left vertebral artery originating from the aorta, precluding standard endovascular repair. An emergent zone 0 physician-modified endograft with partially precannulated dual fenestrations was performed, combined with left vertebral artery transposition and carotid-subclavian bypass. The procedure achieved complete exclusion of the pseudoaneurysm without complications. Follow-up imaging confirmed durable repair and branch patency. Therefore, physician-modified endograft represents a feasible option for emergent BTAI in unconventional anatomies.