Abstract
A patient with complicated Stanford type B aortic dissection and a large ulcer-like projection just distal to the left subclavian artery (LSA) underwent thoracic endovascular aortic repair (TEVAR) using a physician-made 1-cm fenestration and L-shaped marker. This technique allowed accurate alignment with the LSA under fluoroscopic guidance without additional devices. Postoperative and 6-month follow-up computed tomography confirmed good outcomes. This simplified, economical Zone 2.5 TEVAR approach may be a viable treatment option for high-risk patients with anatomically challenging aortic dissections.