Introduction - Surgical management of aortic arch pathologies is complex, and fenestrated aortic arch stenting has recently emerged as a less invasive and safer treatment alternative for pathologies involving the aortic arch. It is unfortunately only available in an elective setting and its long-term results are still unknown. We present our initial experience with fenestrated aortic arch repairs for various pathologies. Methods - All consecutive aortic arch pathology cases which underwent surgical repair in the Department of Vascular Surgery in a single tertiary institution were reviewed. To achieve optimal stent graft dimensions and implantations tactics, pre-operative planning included a computed tomography aortogram to assess anatomic suitability, and stent graft plans drawn up with the aid of the Aquarius iNtuition software (TeraRecon Inc., San Mateo, CA). Anatomic suitability was defined as having a proximal aortic sealing zone of less than 38mm in diameter and more than 20mm in length, the absence of an acutely curved aortic arch, absence of significant aortic tortuosity, and suitable sealing zones in target vessels. Results - From September 2015 to February 2018, five cases of fenestrated aortic arch stentings were performed. The patients were between 57 to 83 years old, all of whom were ASA class II or III. There were three male patients. Indications for surgery included three aortic arch aneurysms, one left subclavian artery aneurysm and one symptomatic type B aortic dissection. All cases were performed under general anaesthesia. In total, three patients had a scallop to the innominate artery, one had a scallop to the left common carotid artery, fenestrations were made to three left common carotid arteries and three left subclavian arteries. In two patients, a left carotid – subclavian bypass performed, and the left subclavian artery origin occluded with a vascular plug. Technical success was achieved in all five patients but one patient developed a right occipital infarct and acute myocardial infarction post procedure. The mean duration of surgery was 164 minutes and the mean length of stay was 4.2 days. The mean follow-up period was 14.4 months, and no endoleaks were detected on follow up imaging. Conclusion - In comparison to traditional open surgery, the use of fenestrated grafts in the aortic arch has emerged as a minimally invasive treatment option with relatively low morbidity and mortality. However, certain limitations still exist, and pre-operative planning is extremely important in ensuring technical and clinical success. Although this procedure appears feasible in the short term, long term results and durability are still being eagerly anticipated.