Endovascular aneurysm repair (EVAR) is a minimally invasive approach to repair of thoracoabdominal aneurysms (TAA) in patients who are poor surgical candidates. Aneurysms that involve the origin of the visceral branches of the abdominal aorta can be challenging to manage due to the inability of conventional stents to manage blood flow to vital organs when using fenestration and snorkeling approaches. Here, we review the efficacy and potential adverse effects of a novel modified octopus technique using an iliac branch device (IBD) in the management of these patients. All patients who underwent two-stage EVAR procedures were identified through our electronic medical record system. Patient comorbidities, sex, aneurysm size and location, and treatment indications were identified along with intra and postprocedural complications. The number of additional stents used in the visceral branches during stage 2 of the procedure was quantified. Average change in maximal aneurysmal dilatation and 30-day and 1-year re-intervention rates related to aneurysm management were calculated. 14 patients were identified in our database. 12 underwent complete 2-stage EVAR between January 2014 and September 2019. One patient is awaiting stage 2 and one patient was not a candidate for stage 2. Seven patients underwent EVAR with modified octopus approach. The celiac trunk, SMA, and bilateral renal arteries were all stented using this approach using 28 additional stents. Intra and postprocedural complications are listed in Table 1. Two patients required re-intervention for endoleak repair. The average change in maximal aneurysmal dilatation was -0.46 cm with 30-day and 1-year re-intervention rates of 0.00% and 28.57%, respectively. There were no aneurysmal ruptures or intraprocedural complications using the modified octopus approach. The modified Octopus approach described here offers a novel alternative to current TAA repair techniques, increasing the number of patients eligible for endovascular intervention. The preliminary results in our retrospective review elucidate the safety, efficacy, and promising outcomes of this innovative approach to TAA repair.Table 1FenestratedPeriscopeSnorkelModified Octopus Using IBDPostoperative ComplicationsEndoleaks1212Rupture0000Central neurologic deficits0001Peripheral neurologic deficits0011Bowel/bladder incontinence0001Thromboembolism0101Small bowel obstruction0010Bleeding requiring transfusion or embolization0210Visceral branch thrombosis0000Graft collapse0000Intraoperative ComplicationsEndoleak0200Rupture0000Bleeding requiring transfusion1110Access site hematoma0210Graft collapse0010 Open table in a new tab