Background: Endovascular chimney technique has been increasingly reported in treating aortic arch pathologies. However, there are still concerns about this technique. The aim of this study is to evaluate the safety and outcome of this technique by performing a systematic review and meta-analysis. Methods: Medline, EMBASE, and Cochrane databases were systematically searched to identify studies on the management of aortic arch pathologies using chimney technique. Studies were reviewed and selected using a priori defined criteria by 2 independent observers who abstracted data on study characteristics, study quality, and outcomes. The extracted data were presented as rate and were converted through arcsine transformations. Individual studies were evaluated and analyzed for 5 ending factors such as technical success, 30-day mortality, patency, perioperative endoleak, and stroke. Heterogeneity of the studies was determined using the chi-square distributionebased Q test and quantified by I 2 statistics. The meta-analyses were performed using both random effects model and fixed-effect model. Results: Twelve studies with a total of 379 patients met the inclusion criteria. The pooled technical success rate of chimney technique was 91% (95% confidence interval [CI]: 87e94%). After patients were treated with chimney technique, the rate of 30-day mortality was 4% (95% CI: 2-7%), the rate of patency was 93% (95% CI: 89-96%), the rate of perioperative endoleak was 21% (95% CI: 17-26%), and the rate of stroke was 5% (95% CI: 3-8%). Conclusions: This study indicates that using chimney technique for treating aortic arch pathologies produced satisfied midterm outcomes in both elective and emergent situations.