Ruptured thoracoabdominal aortic aneurysm treated with physician-modified endograft and in situ laser fenestrations to limit aortic coverage.

The management of thoracoabdominal aortic aneurysms has shifted toward endovascular repair over recent decades. Fenestrated and branched custom-made devices remain largely restricted to elective settings, whereas off-the-shelf branched endografts may be used in urgent cases but are limited by specific anatomic constraints and its fixed design. We report the case of a 73-year-old woman with an extent II thoracoabdominal aortic aneurysm presenting with suspected contained rupture 1 month after a first-stage frozen elephant trunk procedure. Emergent endovascular repair was performed using a physician-modified endograft incorporating two branches and three in situ laser fenestrations. The procedure was successful with an uneventful postoperative recovery.