Acute type B aortic dissection and coarctation: open stent-graft elephant trunk.

We describe a case of acute type B dissection associated with coarctation of the aorta. An intimal tear was located just distal to the coarctation. Aortic dilatation started below the coarctation and extended to the level of the diaphragm. We performed descending aorta replacement from the distal aortic arch to the level of the 9(th) intercostal arteries, and implanted a stent-graft elephant trunk through a left posterior lateral thoracotomy in the 5(th) intercostal space off-pump.