Type B dissection involving a right-sided aortic arch is a very rare condition. Here we describe such an occurrence in an elderly patient who was initially managed medically but later underwent successful surgical repair after developing symptoms of expanding dissection. The dissection was approached through a right thoracotomy. Because of the unusual origin of the arch vessels and the direction of the dissected segment, aortic clamps could not be positioned satisfactorily, necessitating the use of full cardiopulmonary bypass and deep hypothermic circulatory arrest for the repair. The indications for surgery in Type B dissection and the modifications in the surgical strategy necessitated by the abnormal anatomy are discussed.