Thoracic aortic disease, which involves some of the arch vessels, is challenging to treat because of its complex anatomical structure and variation. With the progress and development of endovascular repair technology, in situ fenestration and pre-fenestration have become important measures for the treatment of thoracic aortic diseases. In recent years, there have been a series of reports on the application of in situ fenestration or pre-fenestration in a few centers, and the preliminary results are satisfactory. However, there are some problems such as single operation and small sample size. In order to further compare and analyze the safety and efficacy between the two operations, meta-analysis was conducted by searching Pubmed, Embase, Cochrane, Web of Science, China National Knowledge Infrastructure, Wanfang data, VIP data and China Biology Medicine disc. There was no significant difference in technical success rate, 30-day mortality, endoleak rate and reintervention rate between the two methods. The application of surgical methods can be determined according to the patient's condition and the surgeon's clinical experience.