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A 47-year-old man was admitted to our hospital complaining of chest and back pain. Enhanced CT scan revealed Stanford type A acute aortic dissection. The celiac artery CA was not enhanced and the superior mesenteric artery SMA appeared on the delayed phase. There was a small amount of pericardial effusion. Blood gas analysis showed metabolic acidosis. To treat mesenteric malperfusion, we initially performed thoracic endovascular aortic repair TEVAR by the PETTICOAT technique and stenting to CAdoi:10.4326/jjcvs.48.138 fatcat:ivp22emzdffqfpzpbl5jogwgaq