Purpose Endovascular repair of complex aortic pathologies involving thoracoabdominal, pararenal, and juxtarenal segments remains one of the most technically demanding scenarios, often requiring advanced graft design. Endovascular aortic repair (EVAR) has evolved since the inclusion of fenestrated and branched devices (F/BEVAR), which are now recognised alternatives to open repair, however, their applicability is still limited by technical and anatomical constraints. In this context, inner-branched endovascular aortic repair (IBEVAR) has emerged as an innovative technique, incorporating directional branches within the main graft lumen. This design is intended to facilitate visceral vessel cannulation in narrowed or angulated segments, and to create a more stable environment for bridging stents. Our aim was to evaluate early outcomes for patients treated with IBEVAR at our centre. Methodology All patients undergoing IBEVAR at our institution were retrospectively reviewed. The primary outcome was operative technical success (SVS criteria); secondary outcomes included perioperative morbidity and mortality, reintervention, overall survival, aortic-related mortality, and visceral branch patency. Results Among 14 patients, indications included symptomatic, large, or rapidly expanding pararenal/thoracoabdominal aneurysms, type IA endoleak, and infected pseudoaneurysm. Five patients were treated with off-the-shelf devices and nine with customised platforms. Operative technical success was 93% (13/14); one case had pre-existing critical stenosis of the coeliac and right renal arteries, which were intentionally covered. Two reinterventions occurred: SMA stent angioplasty and embolisation for a type II endoleak. There were three deaths: one from malignancy and two from multiorgan failure. Median follow-up was 487 days (mean 458). Conclusion This single-centre review of the first 14 IBEVAR cases demonstrates promising technical success and acceptable early outcomes. Further studies are needed to assess long-term durability.