Physician-Modified Endograft With Triple Inner Branches for Extensive Aortic Arch Aneurysm

Purpose: The purpose of this case report was to demonstrate the feasibility of a physician-modified endograft (PMEG) with 3 inner branches for extensive aortic arch aneurysm. Case Report: A 69-year-old male presented with extensive aortic arch aneurysm involving all supra-aortic vessels. An Ankura thoracic stent graft was modified with 3 inner branches fashioned of Viabahn endoprostheses. The procedure was technically successful, and the patient was discharged with no complications. Conclusion: This back-table modification of the off-the-shelf endograft is an especially attractive option for complex arch pathologies with urgency and deemed too high risk for reopen surgery.