From January 2008 till May 2013, 16 patients age 55 ± 7 years, had been treated. They were symptomatic, with mean aneurysm dimension of 10 ± 2 centimeters. One patient had Crawford type IV TAAA that was unrecognized, mistaken for tumor and biopsied following explorative laparotomy for acute abdominal pain in another hospital. Surgery was performed through thoracophrenolaparotomy, with construction of composite end to end prosthesis between tubular and bifurcated graft and proximal end to side prosthesis implantation on thoracic aorta. End to end anastomosis with both iliac arteries was performed, followed by implantation of the celiac trunk, superior mesenteric and renal arteries over short 10 mm vascular grafts on the prosthesis.