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Endovascular stent grafting is increasingly used for the management of thoracic aortic aneurysms. Fenestrated grafts are either customized or modified by the physician to suit the anatomy of the patient. Fenestrations are usually made before implantation of the graft; however, they are sometimes done after implantation of the stent-graft, which are in-situ fenestrations. Less than 100 cases have been reported in the literature and none from our country. We report a patient who needed in-situ fenestration and discuss the need and technique of the procedure.