In this innovative technique case report, we describe the off-label use of an iliac branch endoprosthesis and a main body endovascular aneurysm repair component for total endovascular repair of a thoracoabdominal aortic aneurysm in a patient unsuitable for open repair. In the present report, we describe case planning and measurement techniques for this type of repair and postoperative considerations. The take-home lessons include the importance of advanced planning and the overall feasibility of this technique compared with other approaches, including the snorkel technique, in select patients.