Endovascular repair (EV AR) has increasingly replaced traditional open surgery as the treatment of choice for aortic dilatation diseases including aortic coarctation and aortic aneurysm due to its minimally invasive, safe, and effective nature, but the anchorage zone is insufficient, i.e., the distance between the distal or proximal segment of the aneurysm with major branch vessels is less than 1.5 cm, or the aneurysm invades major branch vessels severely. However, the anchorage area is insufficient, i.e., the distance between the distal or proximal segment of the aneurysm with major branch vessels is less than 1.5 cm, or the aneurysm encroaches severely on the major branch vessels. 1, Data and Methods 1.1 General Data From August 2005 to February 2005, our department treated 129 cases of aortic dilatation diseases including aortic coarctation, thoracic aortic aneurysm and thoracoabdominal aortic aneurysm, of which there were less than 6 cases of proximal anchorage zone of aortic coarctation, less than 3 cases of proximal anchorage zone of thoracic aortic aneurysm and less than 4 cases of distal anchorage zone of abdominal aortic aneurysm. 13 patients lacking anchorage zone were male and 3 were female. All six patients with Stanford B-type aortic coarctation had acute onset with acute chest pain as the main clinical manifestation, and patients with aortic aneurysms sought medical attention for abdominal masses or aortic aneurysms found on physical examination. Comorbidities included dilated hypertension in 11 cases, old myocardial infarction in 2 cases, and chronic obstructive pulmonary disease in 3 cases. The use of bypass artificial vessels were ePTFE (5 cases), heparin-coated internal reinforced ring Daxon vessels (4 cases), the use of stent artificial vessels Talenttm (3 cases), Zenithtm (5 cases), and Shanghai minimally invasive stents (5 cases). 1.2 Methods 1.2.1 Preoperative evaluation: The size of the aortic arch rupture, the distance to the left subclavian artery, the distance between the unnamed artery, the left common carotid artery and the left subclavian artery, the blood supply of the left and right vertebral arteries and the development of Willis ring in patients with thoracoabdominal aortic aneurysm were evaluated by dual-source spiral-enhanced CT before surgery, and the abdominal artery, superior mesenteric artery, and suprarenal artery were evaluated in patients with thoracoabdominal aortic aneurysm The involvement and collateral circulation of the celiac artery, superior mesenteric artery and both renal arteries in patients with thoracoabdominal aortic aneurysms were evaluated, and the involvement of the common iliac artery, external iliac artery and internal iliac computer in patients with abdominal aortic aneurysms was assessed bilaterally. to guide the bypass surgical approach and internal iliac artery management. 1.2.2 Creation of a new anchorage zone Create a new distal and proximal anchorage zone using bypass surgery or blocking the internal iliac artery. Right common carotid artery-left common carotid artery bypass: for arch lesions where direct occlusion of the left subclavian artery is evaluated, but the anchorage zone remains inadequate. Right common carotid artery-left common carotid artery-left subclavian artery bypass: for arch lesions evaluated for left vertebral artery dominance. Ascending aorta-unicornuate artery-left common carotid artery-left axillary artery bypass + left subclavian artery occlusion: for arch lesions evaluated to be dominantly supplied by the left vertebral artery, but with a short distance between the three branches of the aortic arch and a large entrapment breach. Infrarenal abdominal aorta-superior mesenteric artery-bilateral renal artery bypass + abdominal cavernous artery ligation:For lesions involving the above-mentioned vessels upon evaluation of thoracoabdominal aortic aneurysms. One-sided internal iliac artery embolization: for infrarenal abdominal aortic aneurysm involving one common and external iliac artery lesion upon evaluation. Bilateral internal iliac artery occlusion: indicated for infrarenal abdominal aortic aneurysm involving bilateral common and external iliac artery lesions upon evaluation, but postoperative concern for pelvic tissue ischemia or gluteal claudication requires internal iliac artery-external iliac artery bypass if necessary. 1.2.3 Endoluminal repair: routine transfemoral endoluminal repair was performed. A total of 4 cases of right common carotid artery-left common carotid artery bypass, 3 cases of right common carotid artery-left common carotid artery-left subclavian artery bypass, 1 case of ascending aorta-none artery-left common carotid artery-left axillary artery bypass + left subclavian artery occlusion, 1 case of infrarenal abdominal aorta-superior mesenteric artery-bilateral renal artery bypass + abdominal artery ligation, 1 case of internal iliac artery embolization 2 cases, and 2 cases of bilateral internal iliac artery occlusion. All patients underwent successful endoluminal repair without any perioperative adverse events, and were followed up by CTA from 2 months to 3 years and 6 months, during which the bridge vessel was patent, the stent artificial vessel was not displaced, the aneurysm lumen was thrombosed, and the volume of the aneurysm lumen did not grow. 3 , Discussion Aortic dilatation disease can be divided into true aneurysms, aortic coarctation and pseudoaneurysms. Traditional open aortic and major branch vessel artificial vessel replacement surgery has increasingly been replaced by minimally invasive EVAR surgery due to the huge trauma and high perioperative mortality and complication rates. However, EVAR surgery has strict requirements for lesion location, aneurysm morphology, and stenting of the artificial vessel access, with the proximal anchorage area < 15 mm being particularly contraindicated for EVAR. In recent years, with the development of understanding and improvement of endoluminal techniques and equipment, more and more surgical methods have been involved in this forbidden area, such as open window technique (Fenestration technique), branch vessel stenting technique (Branch technique), "chimney" technique (Chimney technique) and "hybrid" technique (Hybrid technique). All of these methods aim to obtain sufficient anchorage and ensure blood supply to the vital organs. The so-called "hybrid" technique is a rational combination of traditional developmental surgery and EVAR surgery, which greatly expands the indications for EVAR surgery while avoiding the disadvantages of completely open surgery, which is highly invasive and slow to recover. We use different "hybrid" approaches and endoluminal techniques to reconstruct the anchor zone in the treatment of aortic extension disease lacking an anchor zone to complete the EVAR procedure. True aortic arch aneurysms and entrapment: The cephalic trunk vessels are the main limiting factor for EVAR in arch lesions, where proximity to or invasion of branch arteries may result in inadequate anchorage zones or intraluminal isolation, and hybridization offers the possibility to solve this challenge. For lesions adjacent to the left subclavian artery, it has been suggested that the proximal end of the luminal graft can be safely placed between the opening of the left common carotid artery and the opening of the left subclavian artery, and anatomical studies have shown that the distance between these two arterial openings in adults is approximately 1.0 cm to 1.5 cm, which can satisfy the need for proximal graft anchorage, while the closed left subclavian artery can satisfy the blood supply to the left upper extremity through the countercurrent blood of the left conus artery. However, in patients with an incomplete WILLIS ring and a dominant vertebral artery, there is an obvious risk of brainstem ischemia and infarction with this approach. Therefore, most scholars currently do not advocate blind closure of the left subclavian artery. We carefully evaluate the distance between the proximal part of the lesion and the cephalothoracic trunk, the size of the entrapment breach, the distance between the cephalothoracic trunk and each other, the bilateral vertebral artery supply and the development of the WILLIS ring by CTA or DSA before surgery. In patients with a well-developed WILLIS ring, the distance between the left subclavian artery and the left and right common carotid arteries was greater than 1.5 cm; the left vertebral artery had a dominant blood supply, and the distance between the left subclavian artery and the left and right common carotid arteries was greater than 1.5 cm; the intercalated rupture was larger than 1/2 the diameter of the aorta, and the distance between the left subclavian artery and the left and right common carotid arteries was less than 1.5 cm; the right common carotid artery-left common carotid artery bypass was performed respectively. bypass; right common carotid artery-left common carotid artery-left subclavian artery bypass and ascending aorta-unnamed artery-left common carotid artery-left axillary artery bypass + left subclavian artery occlusion were performed respectively, and good prognosis was achieved by staged or one-stage EVAR surgery after reconstruction of the anchorage area. It avoids extracorporeal circulation and deep hypothermia anesthesia for total arch replacement and ensures sufficient proximal anchorage area to have ensure organ blood supply. Suprarenal thoracoabdominal aortic aneurysm: Because of the involvement of the main branches of the abdominal aorta, the abdominal trunk, superior mesenteric artery, and bilateral renal arteries, suprarenal thoracoabdominal aortic aneurysm has been a contraindicated area for EVAR, and traditional open surgery requires deep hypothermia anesthesia and extracorporeal circulation, with high perioperative mortality and complication rates. The suprarenal thoracoabdominal aortic aneurysm was treated by transabdominal infrarenal abdominal aorta-superior mesenteric artery-bisrenal artery bypass + abdominal artery ligation to reconstruct the distal anchorage zone, and EVAR was performed two weeks after surgery with successful implantation of two stented artificial vessels. The patient recovered well after the operation, with complete thrombosis in the tumor cavity and patency of the bridge vessels at the three-month review, with no clinical manifestations of poor organ blood supply. Subrenal abdominal aortic aneurysm with inadequate distal anchorage zone: A significant proportion of abdominal aortic aneurysms involve bilateral or unilateral iliac arteries, and the common iliac artery distal to the aneurysm does not provide adequate distal anchorage zone during EVAR in approximately 15-30% of cases, requiring a single or bilateral stent prosthesis to extend the iliac branch anchored to one or both external iliac arteries, which may lead to complications such as gluteal claudication, sexual dysfunction, or left hemicolectomy ischemia complications. For unilateral lesions, we used spring-ring embolization of the internal iliac artery on the side of the lesion followed by anchoring of the extended iliac branch to the external iliac artery and the contralateral iliac branch to the common iliac artery to ensure blood supply to the pelvic organs to prevent type II endoleaks. In the two patients with bilateral lesions, the internal iliac artery was severely sclerotic and stenotic as assessed by CTA before surgery, and the EVAR procedure directly anchored the bilateral iliac branches to the external iliac artery, and the patients were closely observed for postoperative manifestations of pelvic tissue and organ ischemia in preparation for extraperitoneal internal iliac artery-external iliac artery bypass. Although both patients presented with gluteal muscle claudication and other manifestations and avoided bypass surgery, we believe that: (1) bilateral internal iliac arteries cannot be routinely blocked; (2) the internal iliac arteries should be carefully evaluated by CTA before surgery; and (3) internal iliac artery bypass surgery should be performed depending on the condition. However, factors such as lesion location and aneurysm morphology limit its widespread implementation. Organic combination with conventional surgery can broaden the surgical indications for EVAR and improve the clinical prognosis of aortic expansion disease.