Thoracic endovascular aortic repair for acute type B aortic dissection in a hypertensive woman with Conn’s Syndrome: A case report

Background: Primary aldosteronism is an increasingly recognized cause of secondary hypertension and carries disproportionately high cardiovascular risk, owing to its direct vascular and myocardial effects. Studies on aortic dissection associated with excess aldosterone remains scarce.
Case presentation: A 53-year-old woman with long-standing, uncontrolled hypertension presented with progressive chest and back pain. Computed tomography (CT), angiography confirmed an acute Stanford type B aortic dissection extending from the distal left subclavian artery. She was noted to have marked hypokalemia, and endocrine testing revealed primary aldosteronism due to a right adrenal adenoma. Given persistent symptoms and high-risk imaging features, thoracic endovascular aortic repair (T-EVAR) was performed. Postoperatively, she developed acute right lower limb ischemia related to vascular access injury, which required iliofemoral bypass. She recovered well with optimized antihypertensive and endocrine therapy and was discharged with plans for interval adrenalectomy.
Conclusion: Aldosterone-mediated vascular remodeling combined with severe hypertension may predispose patients to aortic dissection even in the absence of traditional risk factors. T-EVAR offers a safe and effective therapeutic option for appropriately selected individuals with type B dissection and concurrent endocrine hypertension.