Acute aortic dissection is rarely seen in the patient with a previously repaired abdominal aortic aneurysm (AAA). There are few reports of this in the literature after open aneurysmec- tomy,1,2 and to our knowledge, only one report after endo- vascular AAA repair (EVAR).3 Retrograde dissection was thought to be the cause in this latter case, and this has also been reported after angioplasty or stenting of the thoracic and abdominal aortas, renal arteries, and iliac arteries.4-9 We report