Aortitis is a chronic non-specific inflammatory disease involving the aorta and its major branches, which can cause stenosis, occlusion or aneurysmal changes in the corresponding parts of the blood vessels, and is difficult to treat and prone to recurrence. in December 2008, we successfully treated a case of thoracoabdominal aortic aneurysm combined with multiple visceral artery occlusion by applying the hybrid technique of vascular bypass surgery combined with endoluminal repair, which is reported below. Clinical data Male, 39 years old. left upper abdominal occult pain without obvious cause in January 2007, aggravated after eating, no abdominal distension, black stool, weight loss of about 5 kg. no relief by treatment in local hospital. blood pressure was found to be elevated to 190/110 mmHg in August 2008, and symptomatic treatment was ineffective. The right renal artery and the root of the superior mesenteric artery were completely occluded, and the latter was supplied by the Riolan arch, while the left renal artery was normal. The clinical diagnosis was aortitis and multiple thoracoabdominal aortic aneurysms and occlusive lesions of multiple visceral arteries due to it. On December 3, 2008, an artificial vascular bypass of the abdominal aorta, both renal arteries and superior mesenteric artery was performed through a median abdominal incision. During the operation, the right kidney was found to be significantly shrunken, and the involved visceral arteries were severely adherent to the surrounding tissues, even around the normal lumen of the abdominal aorta and the left renal artery, which was extremely difficult to separate. Two weeks later, a 28-85 mm self-expanding overlapping stent from Yu Hengjia Technology Company was implanted via the right femoral artery to completely cover the four abdominal aortic aneurysms below the abdominal arterial trunk, and the front end of the stent was 15 mm bare. A small amount of type I endoleaks after stent release disappeared completely after treatment with dilating balloons. The angiogram showed that the bilateral renal and superior mesenteric arteries were well supplied by the pre-made artificial vessel bridging. The patient’s postoperative blood pressure was normal and the postprandial abdominal pain disappeared. Prednisone 10 mg/day was continued and he was discharged after 3 weeks with normal sedimentation. Two months after discharge, the prednisone was discontinued. 6 months after follow-up, the hematocrit and blood pressure were normal, and the patient is now living a normal working life. 2. Discussion This case is complex, difficult to treat and clinically rare. Based on laboratory tests and surgical findings, it showed typical signs of aortitis, with both dilated and obstructive arterial lesions due to severe inflammatory lesions in all layers of the arteries, manifested by significant right kidney atrophy, renal hypertension, chronic mesenteric vascular insufficiency and pseudoaneurysm to rupture. In the first stage, a self-sewn trifurcated artificial vessel was used to retrograde bypass from above the bifurcation of the abdominal aorta to both renal arteries and the superior mesenteric artery to solve the problems of visceral arterial supply and the anchorage area for intracavitary repair; in the second stage, an 85-mm-long laminated self-expanding stent was implanted below the abdominal trunk via the right common femoral artery to successfully close four aneurysms, including both renal arteries and the opening of the superior mesenteric artery. While traditional surgical techniques for this lesion are complex and carry significant risks, experience with the application of hybrid surgery is still accumulating. As hybridization often makes visceral blood flow dependent on one or two vessels, precise positioning during release of the intraluminal graft is important, as failure to do so can have catastrophic consequences. The technique requires more compliance and maneuverability of the stented vessels and delivery system. 2007 Chiesa et al. reported mid-term follow-up results of 13 aortic hybridization procedures at 14.9 months, and the prognosis was not significantly better compared to open surgery. Therefore, bulk hybridization cases and long-term follow-up results are still necessary to evaluate their clinical value. The use of open overlapping stents for the first-stage repair of thoracoabdominal aortic aneurysms involving branch vessels has been reported in the national and international literature. As a derivative technique in the process of endoluminal treatment, the advantages of open surgery-assisted endoluminal hybridization in certain complex lesions are obvious. It expands the indications for endoluminal treatment and has the advantages of both open and endoluminal procedures, making it a reasonable, practical and promising treatment modality.