A 42-year-old man presented with acute abdominal pain. He was normotensive and had no history of smoking, diabetes, surgeries, or trauma, but had hypertension controlled with one drug. There was no family history of vascular disease. The physical examination revealed hypersensibility in the lower abdomen, without any palpable mass. Femoral and distal pulses were normal. Ultrasound imaging revealed ectasia of the right common iliac artery (RCIA) and wall hematoma but no free fluid in the abdominal cavity. Computed tomography angiography (CTA) showed a slightly dilated RCIA and dissection from the RCIA to the distal abdominal aorta (retrograde dissection; A/Cover). The patient was placed under general anesthesia, and a transperitoneal approach was initiated. An extensive hematoma and inflammatory reaction were seen next to the anterior wall of the aorta and the RCIA. The site of the RCIA dissection was the iliac bifurcation extending to the distal abdominal aorta. The arterial wall was extremely thin and fragile and was reconstructed using a bifurcated polytetrafluoroethylene graft (B). Histology revealed myxoid degeneration and fragmentation of the elastic fibers of the RCIA. Control CTA imaging on postoperative day 6 did not reveal any problems (C), and the patient was discharged on postoperative day 7 without complications. At 50 days postoperatively, the patient was doing well.