A 51-year-old man was diagnosed with large cell carcinoma of the lung invading to the distal portion of the aortic arch, left subclavian artery, and left vertebral artery (cT4N3M0 stage IIIB). He received concurrent chemoradiotherapy consisting of 4 cycles of cisplatin and vinorelbine with conventional radiation therapy of 60 Gy, which resulted in a partial response. Nine months later, regrowth of the primary tumor was observed. Since there was no lymphatic or distant metastasis and preoperative MR angiography showed that the right vertebral artery was hypoplastic and the blood flow of the basilar artery was mainly supplied from the left vertebral artery, we planned salvage surgery with vascular reconstruction including the left vertebral artery. Thoracotomy was performed through a transmanubrial approach. Because most of the tumor existed in the extra-pleural region, partial lung resection was performed. A bypass graft was established from the ascending aorta to the left common carotid artery and left subclavian artery using a Y-graft. After en-bloc resection, the distal portion of the aortic arch was reconstructed under partial cardiopulmonary bypass. The left vertebral artery was reanastomosed with the subclavian artery graft. The postoperative course was uneventful, and MR angiography revealed that the left vertebral artery was patent.