Utilization of Zenith Alpha Thoracic 2.0 to facilitate physician-modified triple retrograde inner branched endovascular repair of the aortic arch via a single percutaneous femoral access

Fenestrated and branched endovascular aortic repair offers a less invasive alternative to open surgery for complex aortic arch pathologies. However, access to dedicated total arch fenestrated and branched endovascular aortic repair devices remains limited. Physician-modified endografts represent a feasible and adaptable strategy in such cases. In this report, we describe the use of the Zenith Alpha Thoracic 2.0 (ZTA2) (Cook Medical) stent graft in the creation of a physician-modified, triple inner-branched device specifically designed for total endovascular repair of the aortic arch. Key device-specific modifications and procedural techniques that facilitate arch repair are discussed.