Endovascular repair has been increasingly used to treat thoracoabdominal aortic aneurysms using patient-specific or off-the-shelf fenestrated and branched stent grafts. Device customization limits the application of patient-specific devices in patients who need urgent or emergency repair because of ruptured or large, rapidly expanding aneurysms. For these patients, an off-the-shelf multibranched stent graft, the t-Branch stent graft (Cook Medical, Bjaeverskov, Denmark) has been developed based on the relative predictability of visceral vessel anatomy, allowing incorporation and intraoperative customization of target vessels with four down-going directional branches. We used the t-Branch stent graft in a 66-year-old woman with a rapidly enlarging type III thoracoabdominal aortic aneurysm. Completion angiography and follow-up computed tomography angiography demonstrated successful exclusion of the aneurysm sac, patent target vessels, and nearly complete sac shrinkage at the 12-month follow-up.
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