Endovascular stent-graft treatment of penetrating aortic ulcer

Eggebrecht, Holger; Herold, Ulf; Schmermund, Axel; Lind, Alexander; Kuhnt, Oliver; Martini, Stefan; Kühl, Hilmar; Kienbaum, Peter; Jakob, Heinz; Erbel, Raimund; Baumgart, Dietrich

doi:10.1016/j.ahj.2005.05.020

Cited by 74 publications

(63 citation statements)

References 25 publications

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“…Authorities in this area recommend conservative therapy in asymptomatic patients and to consider the evolving and attractive treatment with endovascular stent grafts (12). The number of small case series regarding endovascular treatment of PAUisrapidly increasing (13)(14)(15)(16)(17)(18)(19)(20). In the review by Forda nd Farber (13) comprising 133 patients treated endovascularly,non-successful deployment of the stent graft was only reported in three patients.…”

Section: Treatment Of Paumentioning

confidence: 99%

What to Do When Evidence is Lacking — Implications on Treatment of Aortic Ulcers, Pseudoaneurysms and Aorto-Enteric Fistulae

et al. 2008

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Section: Treatment Of Paumentioning

confidence: 99%

What to Do When Evidence is Lacking — Implications on Treatment of Aortic Ulcers, Pseudoaneurysms and Aorto-Enteric Fistulae

et al. 2008

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“…A total of 76% were considered symptomatic; the inhospital mortality was 0%. No in-hospital death was equally reported by Eggebrecht et al [16] in a series containing 22 cases of PAU, despite the fact that contained aortic rupture was present in 14% (3/22). Besides one minor stroke, there were no other in-hospital complications.…”

Section: Tevar Of Paumentioning

confidence: 79%

“…In recent studies on thoracic PAU, repair resulted in stroke rates which undulate around 4% [3,16,22,46]. Due to evolving device technology-no longer requiring anything except a guide wirethe occurrence of stroke has decreased, as excessive manipulation across a diseased arch can be prevented [30,62].…”

Section: Strokementioning

confidence: 99%

Penetrating aortic ulcer

Bischoff

Geisbüsch

Peters

et al. 2011

Herz

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In addition to classic aortic dissection and intramural hematoma, acute aortic syndrome also includes penetrating aortic ulcers (PAU). The recent advent of highly detailed axial imaging allows closer assessment of PAU and its pathophysiology. However, there is still ongoing discussion about the natural history of the disease, leading to challenging questions concerning the optimal treatment strategy, particularly in asymptomatic patients. In this review, current indications for treatment, with an emphasis on PAU repair in the endovascular era, are discussed.

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“…Initially, we considered that the aortic lesion was ULP with aortic pseudoaneurysm formation, and we selected endovascular stent-graft placement as the treatment because it is effective. 13 In this case, however, the ULP was actually tumor erosion, not an atheromatous ulcer. We suggest that the irregularity of the aortic lumen and circumferential extent of tumor may be characteristic CT findings of a muralbased aortic tumor.…”

Section: Discussionmentioning

confidence: 98%

“…6 There is a male-to-female ratio of 2:1, with an average survival of 1.5 years after diagnosis. 6 Aortic tumors are classified by their (13), leiomyosarcomas (9), and fibrosarcomas (9). 1,5-9 Aortic sarcomas are also described as intimal or mural tumors, depending on their origin within the aortic wall.…”

Section: Discussionmentioning

confidence: 99%

Malignant Fibrous Histiocytoma Arising From the Aortic Wall Mimicking a Pseudoaneurysm With Ulceration

Utsunomiya

Ikeda

Ideta

et al. 2007

Circ J

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rimary malignant lesions of the aorta occur rarely and are associated with a very low survival rate. Common presentations are distal embolic phenomena, 1 aortic dissection, 2 or even occlusion of the aortic lumen. 3 This case report describes a patient with a primary malignant fibrous histiocytoma (MFH) of the thoracic aorta associated with ulcer-like projection (ULP). The aortic mural tumor invaded into the surrounding tissue, not into the aortic lumen, and the radiological appearance mimicked ULP with aortic pseudoaneurysm formation. To our knowledge, a primary aortic tumor with ULP has not been previously reported and knowledge of the characteristic imaging findings is clinically important. Case ReportA 57-year-old woman with a 1-month history of heartburn and who suffered from progressive back pain was admitted to hospital. Her past medical history was rheumatoid arthritis. Physical examination revealed: blood pressure, 130/ 90 mmHg; pulse, 96 beats/min; respiration, 16 breaths/min; and body temperature, 36.8°C. Lung and cardiac sounds were normal. Blood count revealed slight anemia (hemoglobin level: 10.5 g/dl). Other laboratory data, including blood chemistry, coagulation studies, and cardiac enzymes, were not abnormal. Precontrast and contrast-enhanced dynamic computed tomographic (CT) imaging was performed using a 64-row multislice scanner (Aquilion-64, Toshiba). Contrast agent (100 ml) at an iodine concentration of 300 mg/ml (Iomeron, Eisai) was injected at a rate of 4 ml/s, and arterial phase imaging was performed 30 s later. The delay time was 3 min for delayed phase imaging. CT images in the arterial phase showed a 6.5×4.3×6.7 cm aortic Circulation Journal Vol.71, October 2007 lesion with ULP in the thoracic descending aorta (Fig 1).The attenuation values (in Hounsfield units (HU)) were measured at regions of interest (ROIs) in the aortic lesion in each phase. Attenuation of each ROI was 53 HU, 59 HU, and 62 HU on the precontrast CT, arterial-phase, and delayed-phase CT images, respectively. Because the case was initially diagnosed as a pseudoaneurysm with ULP and possible impending rupture, emergency endovascular stentgraft placement was selected as the treatment, using a tailored 100-mm stent-graft device (Gianturco Z-stent with UBE woven Dacron graft material). The immediate post interventional result showed complete exclusion and thrombosis of the ULP (Fig 2). One month after the stent -graft treatment, the ULP was completely excluded but the aortic mass lesion showed no regression in size on CT imaging. Two months later, the aortic mass lesion had increased in size and there was distinct enhancement on contrastenhanced CT imaging (Fig 3). The patient was referred for surgery during which it was found that a tumor of the thoracic aorta had solidly invaded the pulmonary hilus and was considered to be nonresectable. Surgical biopsy was performed. On histological examination, the tumor comprised a haphazardly arranged mixture of pleomorphic spindle and giant cells with frequent mitosis. Immunohis...

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Endovascular stent-graft treatment of penetrating aortic ulcer

Cited by 74 publications

References 25 publications

What to Do When Evidence is Lacking — Implications on Treatment of Aortic Ulcers, Pseudoaneurysms and Aorto-Enteric Fistulae

What to Do When Evidence is Lacking — Implications on Treatment of Aortic Ulcers, Pseudoaneurysms and Aorto-Enteric Fistulae

Penetrating aortic ulcer

Malignant Fibrous Histiocytoma Arising From the Aortic Wall Mimicking a Pseudoaneurysm With Ulceration

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