Background and Aims: Thoracic endovascular aortic repair (TEVAR) has already become the “first-line” treatment for descending aorta pathologies. For lesions involving the aortic arch, physician modified fenestration (PMF) is one of the frequently used techniques for reconstruction of the branch arteries of the aortic arch at present, which refers that the artificial fenestrations are created by removing the membrane of the aortic stent-graft to correspond with the locations of branch arteries after selection of the proper aortic covered stent, and branch vessel stents are deployed through the fenestration-bearing stent in the large artery after it is accurately positioned. This article introduces a PMF method for fast and accurate positioning of the fenestrations corresponding to the branch vessels using the self-contained radiopaque markers of the aortic stent-graft—self-radiopaque marker guiding PMF (S-F PMF), and meanwhile to investigate the technical characteristics and clinical value of using S-F PMF in endovascular treatment of aortic arch pathologies by analyzing the clinical, surgical and follow-up data of a cohort of patients who underwent TEVAR with S-F PMF.  
Methods: The general clinical information, intraoperative technical data and follow-up results of 113 patients with aortic arch diseases who underwent the TEVAR using S-F PMF in the Second Xinagya Hospital of Central South University in China's Hunan province and other state-level cardiovascular centers from 7 different countries during December 2015 to June 2020 were retrospectively analyzed. 
Results: The standard S-F PMF TEVAR procedure was performed in all patients, and the instant success rate of the maneuver was 100%. A total of 118 aortic stent-grafts were implanted in these patients with bridging stents implanted in 35 cases. The operative time was (62.9±17.4) min, time for X-ray procedure was (23.1±9.8) min, the volume of contrast agent used was (81.2±22.5) mL. The accurate positioning rate of fenestration was 98.2%. A bailout stent-graft insertion was performed by chimney technique in one case (0.9%), and a malpositioned opening was successfully corrected in one case (0.9%). Two patients (1.8%) had successful fenestration for simultaneous preservation of the three supra-arch branch arteries, 6 patients (5.3%) had fenestration for simultaneous preservation of  the left command carotid artery (LCCA) and the left subclavian artery (LSA), and the LAS was preserved in 110 patients (97.3%). There is no death and serious complications occurred within 30 d after TEVAR. Type I endoleak was noticed in 7 patients (6.2%). The median follow-up time was 24.5 months. death occurred in 2 patients (1.8%), and occlusion of the branch arteries occurred in 3 patients (2.7%) in postoperative 3 months (2 cases) and 6 months (1 case).
Conclusion: The S-F PMF is an alternative method for reconstruction of supra-arch branches in the treatment of lesion involving the aortic arch. It is a technical progress in methods of total endovascular reconstruction of aortic arch.