We present a case of a ruptured chronic Stanford B dissection of the aorta which was successfully treated with a tapered endoprosthesis using the right axillary artery for access. Challenges to endovascular strategies for thoracic aortic pathology include relatively restricted endoprosthesis configurations and problems associated with endovascular access. Especially in younger patients the right axillary artery should be considered as a possible and safe access for antegrade stent placement.