Progressive dilatation of the false lumen in the arch and descending aorta has been encountered in one-third of survivors as a late sequelae following repair of ascending aortic dissection. Conventional treatment for the same requiring cardiopulmonary bypass and deep hypothermic circulatory arrest is associated with high morbidity and mortality especially in the elderly cohort of patients. Herein we report a case of symptomatic progressive aneurysmal dilatation of residual arch and descending thoracic aortic dissection following repair of type A aortic dissection, successfully treated by total arch debranching and ascending aortic prosthesis to bicarotid and left subclavian bypass followed by staged retrograde aortic stent-graft deployment. This case report with relevant review of the literature highlights this clinical entity and the present evidence on its appropriate management strategies. Close surveillance is mandatory following surgical repair of type A aortic dissection and hybrid endovascular procedures seem to be the most dependable modality for salvage of patients detected to have progression of residual arch dissection. 1. Introduction Dissection of the ascending aorta is a well-recognized medical emergency that warrants urgent surgical repair to save life. This involves replacement of the ascending aorta and reconstruction of aortic root to restore aortic valve competence by repair or replacement, with intent to provide exclusive true lumen flow distally. Progressive dilatation of the false lumen in the arch and descending aorta has been encountered in one-third of survivors as late sequelae following repair of ascending aortic dissection [1]. Conventional treatment of this delayed complication involves open arch repair with elephant trunk procedure requiring cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) with its inherent high morbidity and mortality. Hybrid endovascular therapy is fast evolving as the current standard of care for extensive thoracic aortic diseases. This case report with literature review highlights the clinical entity of residual arch and descending aortic dissection following surgical repair of type A aortic dissection and its effective treatment by hybrid thoracic endovascular aortic repair (TEVAR). 2. Case Presentation 67-years-old retired professor, known hypertensive for 12 years and reformed smoker, underwent repair of type A aortic dissection 4 years back by supracoronary ascending aortic replacement with aortic valve resuspension. He later presented with worsening dyspnoea and left
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