Purpose: To review the early outcome following endovascular repair of pararenal aortic aneurysm using fenestrated stent-grafts and to determine if the number of fenestrations required is predicative of outcome. Methods: A retrospective analysis was conducted of 20 consecutive patients (18 men; mean age of 75±7 years) treated with stent-grafts containing either ≤2 fenestrations (n=10, group 1) or 3 fenestrations (n=10, group 2). Target vessels also included those accommodated by a scallop (renal artery or superior mesenteric artery in group 1 and the celiac artery in group 2). Results: Comorbidities were similar in both groups. Aneurysm size [median 6.9 (IQR 6.7-8.3) versus 6.0 cm (IQR 5.8-6.6), p=0.03], procedure time (mean 6.6±2.1 versus 4.6±1.7 hours, p=0.04), and intensive care stay [median 4.5 (IQR 2-14) versus 2 (IQR 1-3) days, p=0.07] were greater in group 2. There were 2 postoperative deaths, both in group 2. Morbidity was significant and similar in both groups (4 patients in group 1 and 3 patients in group 2), including 1 patient requiring long-term hemodialysis. Target vessel preservation was similar in both groups (96% overall). There were 2 type II endoleaks (one in each group) and no type I or III endoleak. Conclusion: Triple-fenestrated stent-grafts allow patients with extensive pararenal aneurysms and significant comorbidity to be treated by endovascular means. Although the number of patients treated was small, which limited the validity of the comparison, longer procedures and greater early morbidity and mortality were seen in the triple-fenestrated group. At present, the procedures are technically more demanding and associated with increased risk compared with double or single fenestrations, but the technology continues to evolve.