OBJECTIVE To review the indications, operative methods and postoperative management of the "elephant trunk technique", and to report two cases of DeBakey type I aortic dissection treated with the "elephant trunk technique". METHODS Two cases of DeBakey type I aortic dissection were operated with selective cerebral perfusion via the right subclavian artery. At the first stage, a tubular dangling aortic graft prosthesis ("elephant trunk") was inserted into the distal aorta while replacing the ascending aorta and aortic arch. The distal elephant trunk prosthesis was then used at the second stage involving the replacement of the sections of the distal aorta via a left-sided thoracotomy. RESULTS The two operations were successful. Ultrafast computed tomograph (UFCT) showed that the two patients were cured after the first stage operation, and the second stage procedure could have been avoided. CONCLUSIONS The "elephant trunk technique" is a multiple stage approach in the treatment of extensive aneurysmal diseases of the aorta. The procedure is indicated for patients who have combined diseases of both ascending aorta plus aortic arch segments and descending aortic aneurysm. It can also be used for patients with DeBakey type I aortic dissection. Some patients can be cured after the first stage operation.