Objective To compare the efficacy of surgical bypass and in vitro fenestration combined with thoracic endovascular aortic repair (TEVAR) in the treatment of Stanford type B aortic dissection (TBAD) involving the arch. Methods The data of 118 patients with arch TBAD who received surgical treatment in the hospital from September 2018 to December 2022 were retrospectively analyzed. According to the different treatment methods, they were classified into hybrid group and fenestration group. The hybrid group was treated with surgical bypass combined with TEVAR (n=83), while the fenestration group was given in vitro fenestration combined with TEVAR (n=35). The perioperative conditions (surgical time, bedridden duration, postoperative VAS score), perioperative complications (endoleak, postoperative infection, cerebral infarction), Acute Physiology and Chronic Health Evaluation (APACHE II) score before and after treatment, aortic CT angiography (CTA) reexamination at 6 months and 1 year after surgery, re-surgery or intervention rate and death rate were compared between groups. Results The surgical time and bed rest time in hybrid group were longer than those in fenestration group (P＜0.05), and the postoperative VAS score was higher than that in fenestration group (P＜0.05). There were no significant differences in the incidence rates of perioperative complications between groups (P＞0.05). After treatment, the APACHE II score in the two groups was decreased (P＜0.05), but there was no obvious difference between groups after treatment (P＞0.05). At 6 months and 1 year after surgery, no significant differences were shown in the incidence rates of stent thrombosis and type I endoleak between the two groups (P＞0.05). The re-surgery or intervention rate and death rate revealed no significant differences between groups at 6 months and 1 year after surgery (P＞0.05). Conclusion Surgical bypass combined with TEVAR and in vitro fenestration combined with TEVAR have the same efficacy on TBAD involving the arch, but surgical bypass combined with TEVAR has a longer postoperative recovery time, and the surgical method can be selected individually according to the actual situation