Bety M.A.Hongku K.Elkouri S.Drudi L.M.Blair J.F.Charbonneau P.Mahidol University2026-05-312026-05-312026-08-01Journal of Vascular Surgery Cases Innovations and Techniques Vol.12 No.4 (2026)https://repository.li.mahidol.ac.th/handle/123456789/116983Treatment 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.MedicineArticleSCOPUS10.1016/j.jvscit.2026.1022812-s2.0-10503965266124684287