Summary: This is a case of a 61-year-old male patient with a 4.2 cm saccular aneurysm of the distal aortic arch. The aneurysm encompassed the origin of the left subclavian artery, which originated in the same location as the left vertebral artery. This video describes a hybrid approach for management of this patient, with a left vertebral artery transposition and utilization of a Thoracic Branch Endoprosthesis (TBE) for aneurysm coverage.