Objectives To report our experience of a combined open / endovascular repair in patients who have the aortic arch pathology. Methods Between May 2001 and May 2010, 21 patients with a thoracic aortic pathology underwent an endovascular stent-graft repair at our institution. Of them, the patients who underwent a combined open / endovascular repair due to aortic arch involvement were evaluated by medical record and a computed tomography, taken before, just after the completion of the procedure and at followed up. Results A total of 7 consecutive patients (5 men, 71.4%, mean age 59.9짹16.7 years) were implanted a thoracic stent graft for the treatment. Indication for endovascular repair was aneurysmal degeneration in 5 patients (71.4%), rupture or impending rupture in 2 patients (28.6%). In all 7 cases, supra-aortic transposition of the great vessels was performed successfully. Stent graft implantation was achieved in all cases. Primary success rate was in 6 patients (85.7%). Surgical exposure of access vessel was necessary in two patients. A total of 9 stent grafts were implanted (3 stent graft in one patient). The Seal thoracic and the Valiant endovascular stent graft were implanted in 6 and 1 patient, respectively. There was no death or neurologic complication after procedure. In two patients, bleeding and injury of access vessel were noted after procedure. Postoperative endoleak was noted in one patient. During follow-up duration (mean 19.6짹7.3 months, range, 10 to 29 months). One patient died at 10 months after the procedure due to a new developed ascending aortic dissection. There was no one who needed secondary intervention for disease progression during follow-up period. Diameter of aorta decreased in 4 patients. In three patients including one patient who has endoleak, there was no interval change of aortic diameter. Conclusions Our experience suggests that combined open and endovascular repair for aortic arch pathology is safe and effective, with a few complications.