The study of pressure transient behavior in fractured-vuggy reservoirs has recently received considerable attention because a number of such reservoirs have been found worldwide with significant oil and gas production and reserves. In recent years, the use of highly deviated wells (HDW) is considered an effective means for developing this type of gas reservoir. However, in many fractured-vuggy reservoirs unexpected high gas production have been observed which cannot be identified with pressure transient models of horizontal well with pseudo state triple-porosity interporosity flow. This paper presents a semi-analytical model that analyzed the pressure transient behavior of HDW in triple-porosity continuum medium which consist of fractures, vugs and matrix. Introducing pseudo-pressure, Laplace transformation and Fourier transformation were employed to establish a point source and line source pseudo-pressure solutions in Laplace space. Then the pseudo-pressure transient curve was got by numerical inversion. Furthermore, the flow characteristics were analyzed thoroughly by examining the curve which is mainly affected by inclination angle of HDW and interporosity flow coefficients between different pore media. Sensitivity analysis on the pressure transient behavior was performed by varying some important parameters such as the inclination angle, fracture storativity ratio and interporosity flow coefficients. Finally, a field case was successfully used to show the application of the presented semi-analytical model. With its high efficiency, this approach will serve as a reliable tool to evaluate the pressure behavior of HDW in fractured-vuggy carbonate gas reservoirs.