On 11 March 2010, a 51-year-old female on hemodialysis for about 10 years came to our hospital, complaining of abdominal and chest pain during sleep. She also had hypertension for >10 years and her blood pressure was not well controlled. Chest X ray was done, which showed increased lung markings and bilateral lower lung opacities, otherwise unremarkable. She was treated with antihypertensives and discharged. On 30 August 2010, the patient was admitted again because of shortness of breath for 1 week. CXR (Figure 1) showed tortuous and expanded aorta and marked protrudsion of the aortic arch. Aortic CTA showed chest aorta dissection (Debakey III) with thrombosis formation (Figures 2 and and3).3). The cardiac surgeon recommended conservative therapy by lowering the blood pressure below 140/90 mmHg. But the patient still had chest and back pain from time to time, mainly during hemodialysis. In October 2010, arteriography was done in another hospital, which showed a dissecting aneurism on the left subclavian artery, axillary artery and celiac trunk of the descending abdominal aorta. One covered stent was placed on the celiac trunk and one bare stent and two covered stents were placed on the left subclavian artery. After this treatment, the chest pain remitted. But 5 months later, on April, 2011, the patient complained of left hand cyanosis and pain during hemodialysis. Angiography showed obliteration of the lumen of the stents in the left subclavian artery, which caused insufficient blood flow in the left arteriovenous fistula. Then radiocephalic fistula had to be done on her right arm to satisfy the need of hemodialysis. She felt fairly good until February, 2012, when she began to have chest tightness, and shortness of breath. Echocardiography showed enlargement of the left ventricle and systolic dysfunction with LVEF 31% and mitral insufficiency. Then left artery-venous fistula ligation was done and the symptoms ameliorated thereafter.