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Pseudoaneurysm of the ascending aorta is a potentially fatal condition with estimated mortality up to 61% if left untreated. Mortality rates associated with surgical treatment range from 29-46%.There have been isolated case reports and review of the literature detailing endovascular management of this condition. Most have reported short-term success with placement of vascular plugs and occluders to exclude the pseudoaneurysm and induce thrombosis. We report the case of a middle-aged female patient who had undergone total arch replacement with re-suspension of the aortic valve when she presented in extremis with intrapericardial rupture of a type A aortic dissection. She did well, only to present six months later with a pulsatile mass in the mid-sternal region. CTA revealed a large pseudoaneurysm arising from the Dacron interposition graft in the mid ascending aorta. We felt that she was a prohibitive risk for open surgical repair of this pseudoaneurysm, which was at imminent risk of rupture. Additionally, her access vessels were small. We requested the Medtronic Company to release the Valiant Evo device for compassionate use to save the life of this patient. A left subclavian to left common carotid artery bypass was performed as we intended to cover the origin of the innominate and left common carotid arteries which had a common origin. Perfusion to the cerebral vessels would be provided by virtue of the bypass graft being directly perfused from the left subclavian to the left common carotid artery. This coverage of the great vessels of the arch except for the left subclavian artery was necessary to gain a sufficient seal zone distally to provide a durable endovascular repair of the pseudoaneurysm. Access was obtained from bilateral common femoral arteries, which were preclosed. Additionally, the common femoral vein was accessed for rapid ventricular pacing. With rapid ventricular pacing and appropriate hypotension, we deployed a Valiant Evo device just above the sino-tubular junction with the nose cone of the delivery device embedded deep in the left ventricle. The device lay at an angle resulting in an endoleak with the pseudoaneurysm still pressurized. A second Valiant Evo device was next placed in overlapping fashion with the first extending further distally in the arch. The second device corrected the angulation of the first and obtained a perfect seal of the pseudoaneurysm. Six-month follow-up CT indicates complete exclusion of the pseudoaneurysm.