After, Frozen Elephant trunk was achieved by deploying the hybrid quadriforcate prosthesis Vascutek Thoraflex 32/40mm over the guide-wire previously positioned in descending aorta. The prosthesis was then anastomosed to the aorta by means of a running 3/0 prolene suture, with external Teflon felt strip. The systemic flow was re-established via the 10mm perfusion branch of the Thoraflex prosthesis, employing an additional pump, and the prosthesis was clamped proximally. Hemostasis of the distal aortic anastomosis is the established.