Objective: To investigate the feasibility of using in vitro fenestration and scallop in thoracic aortic endovascular repair (TEVAR) for the treatment of aortic arch disease.
Methods: The clinical data 23 patients undergoing TEVAR with in-vitro fenestration and scallop for aortic arch diseases between September 2016 and April 2019 were retrospectively analyzed.
Results: In the 23 patients, the covered stent graft was deployed at proximal landing zone 0 in 3 case, at zone 1 in 6 cases, and at zone 2 in 14 cases respectively. A total of 40 branch vessels were revascularized, including 
3 innominate arteries, 9 left common carotid arteries, 23 left subclavian arteries, 3 aberrant left vertebral arteries and 2 aberrant right subclavian arteries, and of them, 15 cases were reconstructed by scallop and 25 cases by fenestration. The origins of 9 left subclavian arteries were covered, and the technical success rate was 77.5%. Thirty-one branch vessels were patent after operation, one of them developed thrombosis during follow-up and 6 of them were lost to follow-up. Endoleak occurred in 4 patients (17.4%), which disappeared in 2 cases and lessened in one case during follow-up. During the perioperative period, ischemic stroke occurred in 2 patients and death in one patient, but no case of paralysis occurred. 
Conclusion: Using in-vitro fenestration and scallop techniques in TEVAR are feasible and effective methods for the treatment of aortic arch disease.