Massive thoracic aneurysm treatment with preservation of the left subclavian artery

52-year-old-male with a 3-week history of left upper extremity swelling and pain and multiple syncopal episodes. Imaging demonstrated a 10.1 cm saccular thoracic aortic aneurysm arising at the left subclavian artery (LSA). Due to the extension of the aneurysm to the LSA origin, a thoracic branch endoprosthesis (TBE) graft was determined to be his best surgical option for repair. This was performed with a 26×15 cm main body and 10 mm side branch with an excellent recovery. This case demonstrates endovascular aneurysm repair and LSA revascularization with TBE of the largest descending thoracic aneurysm in literature, and we discuss options for repair with comparative analysis.