Simultaneous thoracic and abdominal aneurysms comprise approximately 10–20% of all cases of aortic aneurysms. Whether simultaneous or staged therapy can be used to treat multilevel aortic aneurysms remains controversial. Herein, we report the case of a 79-year-old woman with both huge abdominal and saccular thoracic aortic aneurysms who was referred to our hospital. Multiple stenotic lesions were observed in the major cerebral arteries; moreover, triple-vessel disease was observed on the coronary angiogram. Although this case required immediate primary surgery, cardiopulmonary bypass was difficult due to multiple stenoses in the cerebral arteries. We performed simultaneous surgery with total debranching thoracic endovascular aortic repair, endovascular aortic repair, and off-pump coronary artery grafting. Total debranching thoracic endovascular aortic repair is useful for avoiding neurological complications in cases where cardiopulmonary bypass is difficult. Furthermore, it helps devise an intraoperative cervical branch reconstruction method.