The great improvement in surgical results in the treatment of aortic arch aneurysm is mainly due to progress in supportive measures such as selective cerebral perfusion. With the improvement, the indications for surgery expanded to patients more than 80 years of age or with complications. Nevertheless, such high-risk patients sometimes die or experience complications because open surgery is invasive. To avoid these problems, the less-invasive stent graft has recently been introduced in the treatment of aortic aneurysms, although there are anatomic limits to its use. The patients must also be carefully selected, because even stent grafts sometimes cause embolisms. This article outlines the supportive measures, clinical results, and complications in open aortic arch surgery.