Fig. 3

Schematic of steps of the thoracoscope-assisted fixation technique and implantation of the Surgeon–modified fenestrated stent graft (PMSG) with 4 branches reconstruction. A A metal mark was fixed on the adventitia of the proximal descending aorta. B A Ankura II endograft was deployed proximally. C A double needle suture with 2 felt pledgets was placed. D The suture was knotted and the fixation of the endograft was finished. E The PMSG was deployed with perfect apposition between the fenestrations and the target visceral artery. F Each visceral artery was sequentially stented using Viabahn self-expandable stent. G An Ankura cuff stent was deployed to seal the distal landing zone