Between January 1991 to April 1997, 13 consecutive patients underwent the total aortic arch replacement for distal aortic arch aneurysms. The operation was performed through the median sternotomy and the cardiopulmonary bypass was instituted with the cannulation of ascending aorta for arterial perfusion and of right atrium for venous return. Then the aortic arch was totally replaced with four limbed artificial graft with the aid of selective cerebral perfusion and open distal anastomosis of the distal end of the aneurysm. The mortality was 16% (2 patients) and these cases had ruptured aneurysm and had deep shock preoperatively. There were no severe cerebral complication. Total aortic arch replacement would be the acceptable procedure for the distal aortic arch aneurysm and antegrade ascending aortic perfusion was useful method to avoid the thromboembolic attack due to the retrograde femoral perfusion.