We encountered a challenging case of endovascular repair for distal stent graft-induced new entry (SINE) using the AFX aortic cuff. Distal SINE was detected on follow-up computed tomography in a 68-year-old man who previously underwent primary thoracic endovascular aortic repair for Stanford type B chronic aortic dissection. The AFX aortic cuff was deployed via a previous endograft to just above the super mesenteric artery with blockage of the celiac artery origin. Postoperative computed tomography revealed no endoleak with a preferable conformation change of the externally mounted graft material of the AFX cuff against the tear (active-seal fixation).
