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Background A 40-year-old man presented with acute chest and back pain, hypertension and anuria. Two years previously he had been diagnosed with acute uncomplicated type B aortic dissection. Following conservative management, with aggressive antihypertensive therapy and analgesia, he was monitored with 6-monthly surveillance CT scans. These demonstrated a complicated type B dissection with renal and iliac malperfusion.

Investigations Multislice CT, transthoracic and transesophageal echocardiography, digital subtraction aortography.

Diagnosis Acute-on-chronic type B aortic dissection, complicated by aneurysmal dilatation of the thoracic aorta and visceral malperfusion.

Management Antihypertensive therapy; staged thoracoabdominal and branch vessel endoluminal repair (STABLE procedure), with stabilization of the dissection and rescue of renal function; CT imaging surveillance to monitor for any …