The focus and difficulty in endovascular aortic arch repair is how to maintain the blood flow of the supra-aortic branches with total isolation of the lesion. In situ fenestration can quickly and effectively reconstruct the blood flow of the supra-aortic branches, and its application has gradually expanded the indications of thoracic endovascular aortic repair in the treatment of aortic arch diseases. The development of endovascular technology and the emergence of devices suitable for aortic arch have led to satisfactory short- and medium-term results of the clinical applications of fenestration on a single branch to three branches. The methods of fenestration are mainly mechanical and physical. The former is to use various needles to puncture the fabric, while the latter mainly includes use of thermal energy of laser and radiofrequency to ablate the fabric. This article aims to review the application and progress of in situ fenestration in the treatment of aortic arch diseases.