Anastomotic pseudoaneurysm remains one of the main life-threatening complications after surgery on the thoracic aorta. We report a case with a history of ascending and aortic arch replacement and a false aneurysm creation at the anastomotic line found at the 2-year follow-up computed tomography. Either, due to incidental and asymptomatic finding and patient negation to any kind of intervention, it has been followed the medical treatment with blood pressure and heart rate control. In this, we discuss also the ways of treatment and the indication of any interventional therapy. Endovascular stent-grafting is a minimal invasive treatment for thoracic aortic aneurysm. However, its clinical usefulness for anastomotic false aneurysm following thoracic aortic surgery is unclear.