Introduction
The reports regarding the management of the aortic arch aneurysm with concurrent penetrating atherosclerotic ulcer (PAU) in the descending aorta are very limited. It could be managed by different approaches. In this report, we treated a case with total arch replacement (TAR) with frozen elephant trunk (FET). However, iatrogenic aortic dissection occurred after FET deployment into the PAU. And we analyzed the possible causes and summarized some points to prevent this complication. The study was approved by the institutional review board of Fuwai Hospital. A waiver of informed consent was granted due to the design of the study.