Aortic arch aneurysms are a therapeutic challenge, as they are usually associated with a high surgical risk and their natural history is poorly understood. The authors present a case report of a 74-year-old man, with widespread atherosclerotic disease and an inoperable aortic arch aneurysm. Despite the severity of his condition, the patient survived for four years. Through regular follow-up, it was possible to document th growth mechanism of the aneurysm and the associated complications. We highlight the lack of information in the literature regarding the evolution and natural history of aneurysms of the aortic arch and the urgent need for new therapeutic strategies, especially a percutaneous approach, which could provide better treatment and outcome for high-risk surgical patients.