A 74-year-old man experienced sudden headaches and was diagnosed with acute type A aortic dissection and a 69 mm distal arch aneurysm via CT scan.
The surgical treatment involved total arch replacement using a four-branched graft and an elephant trunk anastomosis, performed through a median sternotomy.
A second procedure for descending aorta replacement was conducted on the 44th postoperative day due to inadequate thrombo-exclusion, but the patient's recovery was smooth afterward.