Introduction - Thoracic endovascular aortic repair (TEVAR) is at present the preferred technique for treatment of a variety of thoracic aortic pathologies. Methods - We present a case of thoracic aortic rupture in which fluoroscopy was not available and transfer to an angiosuite was not possible. Results - A 66-year old female patient without any cardiovascular history presented herself at the emergency department of another hospital because of shortness of breath, progressive fatigue and weight loss with night sweats and chills. Chest X-ray showed a widened mediastinum. Additional CT-angiography revealed a multilobulated mycotic aneurysm just distal to the brachiocephalic trunk. Echocardiography was normal. C-reactive protein was 170mg/l. Conservative treatment with antibiotics was started. After four days, the patient was transferred to our hospital because of progressive growth of the aneurysm for which she had an aortic arch replacement (Gelweave graft 30mm, Vascutek) with supra-aortic branch reimplantation. Within the first 24 hours after cardiac surgery, the patient developed a hemodynamic collapse resulting in cardiac arrest. CPR was performed for more than 40 minutes before achieving sinus rhythm. The patient was rushed to the OR because of massive hemothorax. After establishing extracorporeal circulation (ECC), the diagnosis of descending aortic rupture was made. Open surgical repair was not deemed possible. The patient could not be transferred to the hybrid angiosuite and fluoroscopy with a mobile C-arm was not possible. A 0.035 guidewire was introduced through a 5Fr sheath in the left femoral artery. Transesophageal echocardiography (TEE) confirmed the position of the guidewire near the aortic valve. A Captivia 28*150mm endograft (Gore) was positioned over the rupture and deployed based on echocardiography and palpation of the descending aorta. Bleeding control was only achieved after deployment of a second Captivia 31*150mm endograft (Gore) more proximally. After weaning of the ECC, the patient was transferred to the hybrid angiosuite. Angiography showed patent supra-aortic branches, no endoleak, an overlap of both endografts of more than 5 cm and a patent celiac artery. The patient was weaned off the ventilator and recovered progressively at the intensive care unit. No neurological sequelae were present. Conclusion - This case illustrates that TEVAR should not be denied to patients in case of an emergency situation when fluoroscopy is not available. TEE provides relevant information and is not only an adjunct to fluoroscopy during TEVAR. In the absence of fluoroscopy, it can serve as the primary imaging technique.