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Rationale:   In situ  fenestration may be necessary to preserve branch arteries during thoracic endovascular aortic repair (TEVAR) when there is an inadequate landing zone.    Patient concerns:  We report the case of a 74-year-old man presenting with recurrent hemoptysis.    Diagnoses:  Based on computed tomography (CT) angiogram and bronchoscopy, diagnosis was aorto-bronchial fistula.    Interventions:  We performed retrograde  in situ  fenestration with reentry catheter (Pioneer Plus, Volcano Corporation, San Diego, CA) to preserve the left subclavian artery following TEVAR for aorto-bronchial fistula.    Outcomes:  Following this procedure, the patient had a patent left subclavian artery and no evidence of endoleak. The patient had no further episodes of hemoptysis.    Lessons:  The retrograde  in situ  fenestration with reentry catheter strategy is an option for patients when carotid-subclavian bypass is deemed unsafe.

Case report of retrograde in situ fenestration of the thoracic stent graft with reentry device in a patient with aortobronchial fistula