A 42-year-old man complaining of severe chest pain was referred to our hospital. Computed tomography demonstrated acute type A aortic dissection complicated with rupture in the descending aorta and right leg malperfusion. Initial entry was detected in the proximal descending aorta. He underwent aortic arch, and descending thoracic aorta replacement using selective cerebral perfusion through a left thoracotomy. The leg malperfusion was treated successfully by endovascular treatment on 18th day after the operation. The chest computed tomography three month after surgery demonstrated the disappearance of the false lumen proximal to the anastomotic site and satisfactory outcome.