Treatment of late-presenting malperfusion and aneurysmal degeneration in chronic type B aortic dissection with an off-the-shelf four-vessel inner-branched endograft.

Acute complicated type B aortic dissection is increasingly treated with endovascular techniques to manage contained rupture or end-organ malperfusion. Most cases of malperfusion occur during the acute phase of the dissection. We report a case of a patient treated for late presentation of lower body malperfusion 4 years after successful endovascular intervention for contained rupture of an acute type B dissection. The anatomic complexity required multiple staged procedures culminating in endovascular repair of the paravisceral aorta with an off-the-shelf four-vessel inner-branched endograft, used for the first time, to the best of our knowledge, in North America in the present case. The patient involved provided written informed consent for the report of his case details and imaging studies.