Some extensive thoracic aortic aneurysms are not amenable to staged repair, such as extremely large distal aortic aneurysms that are unsuitable for an elephant trunk anastomosis, or aneurysms that are accompanied by complications such as ruptured descending thoracic aneurysm. We report here a case of successful replacement of the aorta from the ascending to the descending aorta in one operation. The patient was 65-year-old man who had an aneurysm which involved the entire thoracic aorta and ruptured in the descending aorta. The operation was performed via transverse thoracosternotomy, and under the deep hypothermic circulatory arrest with retrograde cerebral perfusion. The patient recovered uneventfully and was discharged without any neurologic complications.