Ruptured Acute Type B Dissection Superimposed on the Abdominal Aortic Aneurysmal Wall Wrapping a Prior Graft

We report a case of a 73-year-old woman with a type B aortic dissection superimposed on the abdominal aneurysmal wall that was wrapped around a bifurcated graft, implanted for a fusiform aneurysm 12 years previously. She was treated conservatively despite evidence of retroperitoneal bleeding because of thrombosis of the entire false lumen at the time of admission. Seven days later she underwent tube grafting on an urgent basis because a new enhanced space appeared around the graft. A small tear at the previous aortic suture line and dissection of the aneurysmal wall that wrapped the prior graft were noted at the time of surgery. The postoperative course was uneventful.