Zone 2 landing at different aortic pathologies: Surgeon-modified fenestrated stent graft

The treatment of aortic pathologies is always challenging for vascular surgeons. Currently, thoracic endovascular aortic repair (TEVAR) is the first treatment option for thoracic aortic pathologies. Left subclavian artery (LSA) coverage during TEVAR can be selectively done; however, revascularization is preferred to reduce the risk of neurological or ischemic complications according to current guidelines. The chimney technique, hybrid operations, back table or in situ fenestrations are assistive TEVAR techniques. Herein, we present three different scenarios in zone 2 landing treated with surgeon-modified fenestrated stent graft (SMFSG). The use of SMFSG for LSA revascularization during TEVAR is feasible, cost-effective, fast, and effective. Durability is of great concern, and the most suitable treatment modality for zone 2 landing necessitates randomized-controlled studies and long-term durability issues.