Objective: To investigate the midterm outcomes of surgeon-modified fenestrated stent-graft for aortic arch pathologies. Methods: We retrospectively analyzed the perioperative period and mid-term follow-up clinical data of 111 patients who underwent thoracic endovascular aortic repair (TEVAR) combined with left subclavian artery (LSA) fenestration in the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2021. Results: Overall, the technical success rate was 100% (111/111), the mortality rate within 30 days was 3.6% (4/111). The median postoperative follow-up time was 33.0 months, the all-cause mortality was 6.3% (7/111), the aorta-related mortality was 2.7% (3/111). Among the main complications, there were 3 patients (2.7%) of cerebrovascular accident, 2 patients (1.8%) of paraplegia, one patient (0.9%) of retrograde type A dissection (RTAD), 2 patients(1.8%) of endoleak, and 3 patients (2.7%) of distal stent-induced new entry (dSINE). Four patients (3.6%) underwent the second aortic intervention, of which 3 patients (2.7%) were performed endovascular surgery and one patient (0.9%) was performed thoracotomy and artificial vascular replacement. Conclusion: The mid-term outcomes of surgeon-modified fenestrated stent-graft for aortic arch pathologies were within the acceptable range, however, further follow-up results are needed and long-term stability and durability needs to be assessed. In addition, the technical process of fenestration needs to be standardized and unified, and related equipment needs to be further developed.