Surgeon-modified endovascular grafts for treating ruptured arch aneurysm due to proximal endograft failure after thoracic endovascular aneurysm repair combined with total debranching.

Generally, proximal endograft failure after total arch debranching and thoracic endovascular repair (TEVAR) is one of the most difficult problems because re-sternotomy poses extremely high risks to patients with high surgical risk. Herein, we report an endovascular technique using surgeon-modified endovascular grafts for a patient with ruptured arch aneurysm caused by type Ia endoleak following total arch debranching and TEVAR.