Penetrating Aortic Ulceration Treated with Castor Branched Aortic Stent Graft—A Case Series

Abstract

Penetrating aortic ulceration (PAU) is an acute aortic syndrome similar to aortic dissection and intramural hematoma. It is the result of a tunica intima ulceration due to atherosclerotic disease. This clinical condition can lead to serious complications and a poor short-term prognosis, especially in high-surgical-risk patients. We report three cases of patients referred to “Ospedale del Cuore” of Massa (Italy) with PAU at the aortic arch-proximal descending aorta level who could not undergo surgical intervention. For the first time in Italy, we successfully treated these patients with a full percutaneous implantation of a Castor branched aortic stent graft. Our case series shows that this type of endovascular graft is an effective, safe, and feasible treatment for PAU involving a distal aortic arch and avoiding surgery and related complications.

Successful Interventional Endovascular Management of Ruptured Penetrating Aortic Ulcer with Associated Enormous Right Pleural False Aneurysm

“…However, for younger patients or those with aortic anatomies not conducive to TEVAR, open repair continues to be an important option. During the acute phase of treatment, TEVAR's technical feasibility and safety profile render it an essential choice for high-risk patients [16][17][18][19][20][21].…”

“…The difficulty in approaching the aorta, the potential for erosion of nearby structures, and the heightened risk of rupturing the false aneurysm during manipulation were substantial concerns. Additionally, the structural integrity of aortic tissue in individuals with PAU may be compromised, posing greater challenge for open graft repairs [20,22]. This inherent fragility necessitates a meticulous approach to intervention, further accentuating the merit of considering endovascular repair as a preferred modality.…”

“…This tailored approach, aligning with international guidelines, ensures that management strategies are fine-tuned to the unique anatomical features of the lesion. Furthermore, as the understanding of PAUs continues to evolve, ongoing research and clinical insights will likely contribute to refining and expanding these guidelines, fostering an increasingly comprehensive and patient-centric approach to its management [1,20,22,23].…”

Outcomes of thoracic endovascular aortic repair with fenestrated surgeon-modified stent-graft for type B aortic dissections involving the aortic arch

“…In the early stage, custom-made branched stent-graft was used, allowing personalized treatment, while the process of measurement and manufacture took more than 1 month, preventing its usage in the emergent condition. Castor single-branched stent graft is the first off-the-shelf single-branched stent graft for the preservation of LSA in China, which had also been approved in Europe ( 16 ). However, double/triple branched stent graft was still under investigation due to the various anatomy patterns of the aortic arch, especially when more than one supra-aortic trunk needs reconstruction.…”

Case Report: Role of numerical simulations in the management of acute aortic syndromes

“…Current guidelines from Europe and the United States suggest that surgical intervention should be considered for lesions involving the ascending aorta ( 1 , 2 ). However, the risks associated with open surgery, particularly in older patients with significant comorbidities, make endovascular approaches more attractive ( 5 ).…”