Schematic diagram of the operation. After the distal ascending aorta was transected at the base of the innominate artery and the arch was longitudinally opened at the anterior wall (A), the arch vessel orifices and the true lumen of the descending aorta could be clearly seen (B). The modified triple-branched stent graft was inserted and deployed into the true lumen of arch, proximal descending aorta and 3 arch vessels (C, D). Each sidearm stent with the size proportional to that of corresponding arch vessel was selected and anchored into the implanted sidearm tube graft (E, F, G). The arch longitudinal incision was closed with incorporation of the main tube graf (H). Finally, the arch stent was inserted and deployed into the main tube graft (I, J). The transected distal stump incorporating the main tube graft and the polyester fabric felt of the arch stent was directly anastomosed to the distal end of the 1-branched Dacron tube graft (K). If type 1 modified triple-branched stent graft was used, only the tube graft for arch and the arch stent were implanted separately (L).