The objective of this case series is to investigate the outcomes of double-fenestrated physician-modified endografts (PMEGs) in patients with distal anastomotic aneurysms following open repair of the ascending aorta or proximal arch replacement. All consecutive patients with a distal anastomotic aneurysm following open ascending aorta surgery who underwent aortic arch repair with a homemade double-fenestrated stent-graft from 2017 to 2023 were reviewed. Study endpoints included technical success, 30-day, and long-term follow-up analysis of mortality, morbidity, and re-interventions. 10 patients were treated with double-fenestrated PMEGs for anastomotic aneurysms following open surgery of the ascending aorta. Of these, nine were male with a mean age of 58 years. Nine patients were initially treated for acute dissection, and two had mechanical aortic valves. The mean time between open surgery and the treatment of the pseudoaneurysm was 4.15 years. Technical success was 100%. The proximal landing zone was consistently in zone 0, and all endografts were deployed via femoral access. Early outcomes revealed one endoleak (type 1a), which was successfully treated by prompt reintervention. No deaths or strokes occurred during the early postoperative period. During long-term follow-up (mean time 35 months), no endoleaks requiring intervention occurred, and there were no reports of stent fractures or migrations. No patient died from an aortic-related cause. Aortic arch repair with double-fenestrated PMEGs for distal anastomotic aneurysms after open surgery is feasible and represents a promising alternative in patients ineligible for redo surgery.