Healthcare systems are increasingly challenged by natural disasters, armed conflicts,terrorist attacks,cyberattacks,infrastructure failures, and other large-scale emergencies.While emergency medicine, surgery and intensive care are traditionally viewed as the cornerstones of disaster response, radiology is often overlooked in preparedness planning. Modern emergency care depends on timely diagnostic imaging. When imaging becomes unavailable, patient flow shows, surgical decisions are delayed, and hospital capacity rapidly deteriorates

Extensive chronic type B aortic dissection with complex aortic arch anatomy poses a challenging therapeutic problem, especially in younger patients. A particularly challenging category of patients comprises those at high risk and those with borderline measurements involving other segments of the aorta. The patients classified as high-risk if they had refractory arterial hypertension despite optimal medical therapy, overweight, diabetes mellitus, refractory pain syndrome localized to the thoracic spine, or a syndrome of dynamic hypoperfusion of the visceral organs. Borderline aortic measurements are defined as an ascending aortic diameter of 45–50 mm, an
aortic arch diameter of 40–45 mm, or partial retrograde extension of the dissection into the aortic arch.
We report the case of a 49-year-old man with extensive chronic type B aortic dissection involving the descending thoracic and abdominal aorta, with aneurysmal dilatation of the false lumen of the descending thoracic aorta and complex aortic arch anatomy. A planned two-stage hybrid approach was performed. The first stage consisted of supracoronary full-root replacement of the ascending aorta with supra-aortic debranching and extra-anatomical rerouting of the brachiocephalic trunk, left common carotid artery, and left subclavian artery to the ascending aortic graft. Two weeks later, the second stage involved endovascular reconstruction of the aortic
arch and descending thoracic aorta using two stent grafts. The postoperative courses following both procedures were satisfactory.
Follow-up computed tomography angiography demonstrated satisfactory patency of the aortic arch branches and endoprostheses. However, persistent partial thrombosis of the false lumen with residual contrast opacification and a distal type II (retrograde) endoleak was observed in the descending thoracic aorta, without significant interval enlargement. At approximately 19 months after the second-stage procedure, the reconstructed segments remained patent, while partial false-lumen thrombosis and residual contrast opacification persisted in the proximal descending thoracic aorta. This case illustrates the feasibility of a staged hybrid approach in selected patients with extensive chronic type B aortic dissection and complex aortic anatomy. It also highlights that successful
reconstruction does not necessarily achieve complete false-lumen exclusion and underscores the importance of long-term imaging surveillance to monitor aortic remodeling, endoleak persistence, and repair durability.