Chronic DeBakey Type IIIB Aortic Dissection Presenting Acutely: A Diagnostic and Surgical Challenge in an Elderly Hypertensive Patient.

Aortic dissection is a rare but life-threatening condition requiring prompt diagnosis and intervention. We report the case of a 74-year-old woman with a history of long-standing hypertension who presented with sudden-onset tearing abdominal and lower back pain. Initial evaluation revealed hypotension, diminished femoral pulses, and a diastolic murmur, raising suspicion for acute aortic pathology. Imaging confirmed a chronic DeBakey type IIIB (Stanford type B) aortic dissection extending from the left subclavian artery to the iliac arteries, associated with aneurysmal dilation, a saccular pseudoaneurysm, extensive atheromatosis, and signs of malperfusion. Emergent surgical repair with a multi-branched aortic graft and valve-sparing aortic root replacement was successfully performed. This case highlights the diagnostic challenges posed by chronic dissections presenting acutely, the limitations of relying solely on aortic diameter for risk assessment, and the critical importance of early recognition and comprehensive imaging in guiding timely, life-saving interventions.