Backgroud: Endovascular approach to the thoracic aortic aneurysm or dissection is an appealing solution. But, this technology alone is not often no suitable to complex aneurysm or dissection. The purpose of this study is to evaluate the technical and clinical outcomes of hybrid approaches in complex thoracic aortic aneurysms or dissections. Methods: 7 patients (mean age, 57 years; range, 38-86 years) underwent hybrid approaches for the lesions, including 2 patients underwent stent graft implantations due to recurrent dissections of aortic arch and descending thoracic aorta, following a prior surgery. 5 patients (2 aneurysms and 1 dissection of aortic arch, 2 aneurysms of descending thoracic aorta) underwent adjunctive surgical maneuvers to overcome the limitation of endovascular procedure due to inadequate proximal landing zone. Among them, 1 patient received right common carotid artery to left common carotid artery bypass and endovascular stent grafting for left subclavian artery pseudoaneurysm. 4 patients received arch reconstructions or debranchings before endograft placement, including 1 patient who had elephant trunk creation. Results: During a 17 month period (range, 2.6-49.3 months), technical success was achieved in all patients. There was no perioperative death. 2 patients had endoleaks on follow up CT scans. 1 patient had immediate type II endoleak, which were resolved by the 2 months follow up. But, 1 patient, who had persistant type I endoleak, received another stent graft implantation 9.7 month after. The incidence of clinical success was 85.7% (6/7). Conclusions: Our study showed that the hybrid approach for complex thoracic aortic lesions was effective. However, additional experience and longer follow up is needed before expanding current indications for this approach.