Introduction
The impact of the COVID-19 pandemic in New York City is dramatic. COVID-19 cases surged and hospitals expanded to meet the need. Elective surgical cases were cancelled due to concern about hospital beds and the risk of perioperative COVID-19 infection. This same concern contributed to the dramatic decrease in non-COVID-19 emergency cases presenting to the hospital which was associated with a dramatic increase in the at-home deaths during this same period according to the contact with [Reference is contact with FDNY regarding EMS at home death findings March-April 2020]. During this unprecedented time, a young woman with known Marfan Syndrome (MFS) presented with an acute complicated type B aortic dissection (ACTBAD).
Thoracic endovascular aortic repair (TEVAR) is the procedure of choice for ACTBAD. TEVAR is not recommended for Marfan syndrome (MFS) patients, but it could be potentially beneficial under critical circumstances [1, 2]. Use of the Provisional Extension to Induce Complete Attachment (PETTICOAT) technique has been demonstrated to decrease the risk of spinal cord ischemia in comparison to use of covered stent grafts in similar settings [3-6].