The purpose of this article is to report successful hybrid treatment of a sovraprosthetis type IV thoracoabdominal aneurysm. This technique was used in a 65-year-old man with chronic rupture of a type IV thoracoabdominal aneurysm not suitable for aortic cross-clamping because of a severe cardiopathy (left ventricular ejection fraction 20%); the patient underwent previous repairs of aortic arch and infrarenal abdominal aortic aneurysms. Perioperative complications were absent. Postoperative day 21 computed tomography and monthly duplex ultrasonography confirmed the complete exclusion of the aneurysm with proper perfusion of visceral vessels. At the seventh postoperative month, the patient died of a massive recurrence of myocardial infarction. Hybrid treatment for thoracoabdominal aneurysms may represent a valid solution for those patients with poor cardiac and respiratory reserve, reducing cardiac stress and the duration of visceral ischemia, which are still the main causes of morbidity and mortality for this type of intervention.