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A 33-year-old female with Marfan syndrome presented in 1996 with acute peripartal aortic dissection. A composite graft was performed and intestinal resection had to be performed a few days later because of malperfusion-related ischemia. Recovery of the mother and the child was uneventful. In 2000, complete thoracoabdominal replacement was necessary because of expanding aneurysm Crawford type II, but the aortic arch was normal sized. The proximal anastomosis was performed at the level of the left subclavian artery by invaginating a piece of the graft into the descending prosthesis (reversed elephant trunk) to facilitate ulterior aortic arch replacement.