Physician-modified "fenestrated" Gore thoracic branch endoprosthesis (TBE) for zone 0 hybrid arch repair

Despite advances in endovascular repair of aortic arch pathologies, the gold standard remains open surgical repair. Two single-branched options for zone 0 exist in the United States for high-risk patients. Both systems require adjunctive multiple cervical debranching, which carries significant morbidity. We describe a practical endovascular solution that simplifies modification, implantation, and adjunctive cervical debranching, by performing a single left carotid transposition and creating an additional fenestration within the existing Gore thoracic branch endoprosthesis platform. We present our initial series of six patients.