Surgical treatment in a nonagenarian with thoracic aortic aneurysm is challenging, and the surgical indication in such patients is controversial. A 92-year-old female patient with severe chest and back pain was transferred to our hospital because of impending rupture of an aortic arch aneurysm with normal mental activity. Physical and laboratory examinations were within normal limits. The patients underwent urgent graft replacement of the total aortic arch. Postoperative course was uneventful and the patient remains well with no disability 8 months after the operation.