Introduction - Salmonella aortitis is a rare and rapidly progressive pathology that requires early surgical intervention. In recent years, endovascular grafts have increasingly been utilised for this purpose with promising outcomes but a new set of complications. We describe a case of salmonella aortitis managed with early endovascular grafting complicated by Stanford Type B aortic dissection involving the left renal artery. Methods - Case Report Results - An 83 year old male presented with a 2-day history of fevers and back pain. He had a history of rheumatoid arthritis not being treated with steroids or immunosuppressive agents, hypertension and hypercholesterolaemia. He was diagnosed with salmonella enteritidis infrarenal aortitis on blood culture and CT scan, and was commenced on intravenous antibiotics. However, progression demonstrated on CT of a penetrating aortic ulcer the following day prompted urgent treatment with an endovascular graft. Intraoperative completion angiography demonstrated satisfactory graft positioning immediately inferior to the left renal artery origin and exclusion of the ulcer. However, a progress CT scan 7 days later showed a retrograde aortic dissection from the origin of the left renal artery extending proximally to the left subclavian artery origin. The left renal artery was perfused via both the true and false lumens; the left kidney appeared adequately perfused and the patient had a normal serum creatinine. The patient developed left renal corticol infarcts seen on CT 2 weeks later but continued to have normal serum creatinine and stable renal artery dissection. The patient followed up routinely at 3 months when his serum creatinine had more than doubled; a MAG3 perfusion scan showed markedly reduced left renal perfusion as well as function. This prompted endovascular treatment with a left renal artery stent with restoration of true lumen flow to the left kidney. However, although his creatinine had mildly improved, his follow up MAG3 scan showed no resultant improvement in perfusion or function of the left kidney. Conclusion - This case demonstrates that renal artery dissection can lead to significant subclinical malperfusion and malfunction of the kidney. Dedicated renal perfusion and function studies such as a MAG3 scan should be considered early in these cases to determine the need for intervention before irreversible consequences occur.