Repeat endovascular exclusion for distal tear after treatment of primary aortic dissection by endovascular exclusion

An obese, hypertensive, 70-year-old man was found to have an extensive chronic Stanford type B aortic dissection. The dissection was treated by placement of a stent graft. One year later, he developed a small protrusion of the intimal flap at the distal end of the stent graft that gradually enlarged, until 4 years after the procedure, it had become disrupted, and angiography showed contrast medium entering the false lumen. A second stent graft was successfully placed, and imaging 2 years later indicated no recurrence of the tear, endoleak, or malperfusion of the aortic arch vessels.