Background: Mechanical haemolytic anaemia is a rare but recognised complication of prosthetic aortic grafts, typically arising from turbulent flow across a dysfunctional graft or valve. Graft infolding causing significant luminal stenosis is an exceptionally uncommon aetiology, and its management in high-risk surgical candidates presents a formidable clinical challenge. Case Presentation: A 62-year-old male presented with transfusion-dependent mechanical haemolytic anaemia attributed to suspected infolding of a previously implanted ascending aortic graft with haemodynamically significant stenosis. His surgical history included four prior sternotomies with redo aortic valve replacement and ascending aortic reconstruction within a porcelain aorta, rendering open repair prohibitively high risk. A multidisciplinary endovascular-first strategy was adopted. IVUS confirmed significant stenosis at the graft infolding site. Under rapid ventricular pacing, a 40 mm Gore TAG thoracic endoprosthesis with luminal cuff was deployed across the defect, followed by post-balloon dilatation. Completion IVUS demonstrated wide luminal patency with no residual stenosis. Pullback pressure measurements across the aortic valve, ascending aorta, stented segment, and arch confirmed no residual pressure gradient. No immediate postoperative complications were observed. The patient was discharged with postoperative haemoglobin normalised and transfusion independence achieved. Conclusion: This case demonstrates that zone zero TEVAR is technically feasible and clinically effective for graft infolding-related haemolytic anaemia in patients deemed inoperable. Endovascular management of ascending aortic pathology may offer a viable rescue strategy in the highest-risk redo surgical patients.