P>Open surgical repair after failed endovascular aneurysm repair usually involves complete aneurysm removal and replacement with a prosthetic surgical graft. We describe an alternative strategy of open surgical repair of a thoracoabdominal aneurysm repair after failed endovascular aneurysm repair that entails preserving the functioning portion of the endograft and sewing the thoracoabdominal graft on the existing abdominal endograft. (J Card Surg 2010;25:554-556).