Background and Aims Thoracic endovascular repair (TEVAR) has become the first choice for the treatment of aortic arch lesions. However, this procedure requires a proximal landing zone of at least 15 mm in length, so reconstruction of the major branches of the aortic arch is usually necessary to ensure the safety of the operation in those with insufficient landing zone. Among the current reconstruction techniques, in-situ fenestration technique is most frequently used, because of its greater level of the supra-aortic branch preservation and relatively low risk of endoleak. Therefore, this study was to investigate the feasibility and effect of application of in-situ needle fenestration of Ankura aortic stent graft for revascularization of the supra-aortic branches.Methods The clinical data of 47 patients with aortic disease and short proximal landing zone treated in Ningbo Hwa Mei Hospital of University of Chinese Academy of Sciences from March 2017 to December 2020 were retrospectively analyzed. Among them, there were 38 cases of thoracic aortic dissection, 6 cases of thoracic aortic aneurysm, and 3 cases of thoracic aortic ulcer. According to the preoperative CTA image data, the number of fenestrations and the size of the fenestration stent were determined; during the operation, the Ankura aorta stent graft was used to perform in-situ fenestration and reconstruction of the supra-aortic branches. Aortic CTA regularly performed after surgery.Results All patients were successfully operated. A total of 47 Ankura thoracic aorta stent grafts, 51 Gore Viabahn stent grafts, and 20 Cordis Smart bare stents were implanted. Four cases were converted to chimney stent implantation during the operation. The success rate of in-situ fenestration was 91.5% (43/47), which included left subclavian artery (LSA) fenestration, left common carotid artery (LCCA) fenestration+LSA embolization in 1 case, LSA fenestration+ in 29 cases left vertebral artery chimney in 1 case, LSA fenestration+LCCA chimney in 9 cases, LCCA and LSA fenestration+innominate artery (IA) chimney in 1 case, and LCCA fenestration+IA chimney+LSA embolization in 2 cases. The operative time for the whole group of patients was 160-300 min, with an average of (200±20) min, and the operative time for fenestration was 18-45 min, with an average of (30±8) min. Postoperative endoleak (type 1) occurred in 3 cases, retrograde tear occurred in 2 cases (1 case improved after ascending aorta replacement, and 1 case died), cerebral infarction occurred in 2 cases, and no paraplegia occurred. The average follow-up time was (28.4±14.7) months. During the follow-up period, the endoleak disappeared in 2 cases and did not further increase in 1 case, which was treated by observation, and there was no occlusion in the fenestrated branch vessels.Conclusion Using in-situ needle fenestration of Ankura aortic stent graft for revascularization of the supra-aortic branches is a feasible and effective treatment method, with favorable short-term results.