With the endovascular revolution upon us, the management of aortic aneurysmal disease has changed dramatically. Since 1991, more than 100,000 aneurysms worldwide have been repaired using early-generation and current-generation standardized grafts and this has dramatically reduced the 30-day mortality rates associated with open aortic surgery. A new phenomenon has also arisen from this wonderful technology. The term hybrid means "of different origins" and hybrid approaches to vascular disease involve open and endovascular techniques to achieve a common goal, namely, to prevent death caused by aneurysmal rupture. This article reviews novel approaches to the repair of complex aortic aneurysms and provides several illustrative examples.