This review evaluates branched and fenestrated thoracic endovascular aortic repair (B-/F-TEVAR) for aortic arch pathologies. Technical success rates are high (84-100 percent), with 30-day mortality ranging from 0–25 percent and stroke rates between 3–36 percent. Fenestrated repairs show lower mortality (2 percent in some studies) for lesser curvature pathologies, while branched repairs offer greater anatomical adaptability but have higher stroke rates. The authors conclude that B-/F-TEVAR is feasible for high-risk patients with complex aortic arch disease; however, stroke remains a significant concern, and reintervention rates indicate durability challenges.