Endovascular Treatment of Penetrating Aortic Ulcers: Mid-term Results

Abstract

Endovascular treatment of penetrating aortic ulcers of the descending thoracic and infrarenal aorta were safe and effective in the mid-term in this small series of patients.

Endovascular therapy for penetrating ulcers of the infrarenal aorta

“…The mean age of their cohort was 74 years, with similar numbers of men and women, and a significant rate of hypertension (78%), coronary artery disease (72%), diabetes mellitus and renal insufficiency (28%) among their patients. Renal impairment was a constant demographic finding in thoracic and aPAU studies, occurring in 9–41% and from 15.4% to 20.0% of the cohorts, respectively. This finding might be attributed to the high burden of atherosclerosis in renal patients.…”

“…PAU diagnosis was confirmed by at least two reviewers in all cases, either at contrast‐enhanced computed tomography (CT) or CT angiography (CTA) scans. Isolated PAU disease was defined as the presence of at least one focal contrast material‐filled, crater‐like outpouching protrusion of the endoluminal border of the aortic wall that was localized in an area of significant intima calcification . In such cases, a local dissection flap or false lumen must not be recognized .…”

“…Penetrating atherosclerotic ulcer (PAU) of the aorta is a rare but potentially life‐threatening entity . It is the least dangerous aetiology (3%) of aortic syndrome, which is also caused by classical dissection of the aorta (80%) or by intramural haematoma (IMH) of the aortic wall (17%); all of these are closely related due to the similar clinical features and eventual catastrophic progression . PAU is defined as atherosclerotic mural plaque ulceration with subsequent penetration of the elastic lamina into the media, leading to haematoma formation within the media layer of the aortic wall.…”

“…PAU is defined as atherosclerotic mural plaque ulceration with subsequent penetration of the elastic lamina into the media, leading to haematoma formation within the media layer of the aortic wall. The natural history of this weakening of the aortic wall is unpredictable and extremely variable, as it may be potentially complicated by a contained aortic IMH, progression of the haematoma to aortic dissection, sub‐adventitial pseudoaneurysm formation or aortic perforation . Open surgical repair with synthetic graft has been the gold standard of treatment, but endovascular therapy is emerging as an attractive, minimally invasive alternative that is suitable for frail elderly patients who are the primary sufferers of this condition.…”

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

“…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.…”