Renal failure may occur in 18% of patients presenting with a type I aortic dissection. 1 Although performing a frozen elephant trunk at the time of the initial repair may decrease the size and extent of the distal false lumen, 2 malperfusion may still occur, which will require a multidisciplinary team of cardiac and vascular surgeons and interventional radiologists for the optimal management of this complication. 3 We present images of a patient who developed acute renal failure following the repair of a type I dissection due to an expanding false lumen, which was successfully treated with thoracic endovascular stent replacement (TEVAR).A 56-year-old male was admitted with acute chest pain and was found on a computed tomography (CT) scan to have a 5.8-cm ascending aorta with an intimal flap from the aortic root extending into the descending aorta ( Figures 1A and 1B). The abdominal aorta was normal in size with no evidence of dissection. At the time of surgery, cardiopulmonary bypass was initiated with femoral arterial and right atrial cannulation. Following circulatory arrest, the dissection was FIGURE 2 Computed tomography of an aorta showing the collapse of the true lumen at the descending aorta (arrows) FIGURE 1 Computed tomography of an aorta showing (A) the dissected ascending aorta and (B) proximal descending aorta J Card Surg. 2018;33:857-858.wileyonlinelibrary.com/journal/jocs