Visceral/renal artery debranching can lengthen the distal landing zone in patients with complex thoracoabdominal aortic disease, thus enabling endograft repair. Initial reports of "hybrid" procedures are promising, but they usually describe transperitoneal visceral/renal artery exposure. This clinical series describes four complex thoracoabdominal aortic aneurysm/dissection cases in which the visceral and renal artery debranching procedure was accomplished via a retroperitoneal approach.