Penetrating atherosclerosis aortic ulcer: a re-appraisal

Hassani, Imane El; Damme, Hendrik Van; Creemers, Etienne; Boesmans, Evelyne; Defraigne, Jean-Olivier

doi:10.1080/00015458.2016.1212566

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…In contrast, endovascular treatment is a less invasive alternative that is widely performed (70% of cases) with low complications rates (0-11%). [24][25][26] Literature reviews show that PAU is associated with high risk of rupture (20-50%) and mortality (80%) and urgent surgical treatment is recommended. 1,17,18 For isolated acute abdominal aorta dissections with refractory abdominal pain and limb ischemia or for chronic aneurysm degeneration, endovascular treatment is associated with lower mortality rates and perioperative complications.…”

Section: Discussionmentioning

confidence: 99%

Unibody design for aortic disease with a narrow aortic bifurcation: tips and tricks for success

Yoshida

Costa²,

Cunha³

et al. 2021

J. vasc. bras.

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Background Surgical management of patients with abdominal aortic diseases associated with distal narrowing is a challenging situation. Objectives To evaluate outcomes of unibody bifurcated endovascular stent graft repair. Methods This is a retrospective, observational, multi-institutional database study of a cohort of consecutive cases, approved by the local Ethics Committee. Records were reviewed of patients diagnosed from 2010 to 2020 with “shaggy” aorta, saccular aneurysm, penetrating aortic ulcer, and isolated aortic dissection located in the infrarenal abdominal aorta. All patients were treated with a unibody bifurcated stent graft. Main outcomes were technical success, procedure complications, long-term patency, and mortality in the follow-up period up to 5 years. Data on demographics, comorbidities, surgical management, and outcomes were analyzed. Results Twenty-three patients were treated with unibody bifurcated stent graft repair, including 7 cases of “shaggy” aorta, 3 isolated dissections of the abdominal aorta, 4 penetrating aortic ulcers, and 9 saccular aneurysms. Immediate technical success was achieved in 100% of cases. At follow-up, all stent grafts remained patent and there were no limb occlusions. The patients were symptom-free and reported no complications related to the procedure. There were 5 deaths during the follow-up period (median= 4 years), but none were related to the procedure and there were no aorta-related deaths. Conclusions The present study shows that unibody bifurcated stent grafting is safe and effective in this group of patients with narrow distal abdominal aorta and complex aortic pathology. The results were similar for both infrarenal aortic aneurysms and aorto-iliac atherosclerotic disease.

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Section: Discussionmentioning

confidence: 99%

Unibody design for aortic disease with a narrow aortic bifurcation: tips and tricks for success

Yoshida

Costa²,

Cunha³

et al. 2021

J. vasc. bras.

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“…Most PAUs are asymptomatic and do not require urgent invasive treatment. However, it may be a progressive disease leading to a saccular (pseudo)aneurysm, AD, or transmural aortic rupture (40% of symptomatic PAUs), and emergency invasive therapy (often TEVAR) is recommended [ 21 , 24 , 25 , 89 , 90 , 91 ].…”

Section: Acute Aortic Syndrome (Aas): Dissection and Variantsmentioning

confidence: 99%

MDCT Imaging of Non-Traumatic Thoracic Aortic Emergencies and Its Impact on Diagnosis and Management—A Reappraisal

et al. 2022

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Non-traumatic thoracic aorta emergencies are associated with significant morbidity and mortality. Diseases of the intimomedial layers (aortic dissection and variants) have been grouped under the common term of acute aortic syndrome because they are life-threatening conditions clinically indistinguishable on presentation. Patients with aortic dissection may present with a wide variety of symptoms secondary to the pattern of dissection and end organ malperfusion. Other conditions may be seen in patients with acute symptoms, including ruptured and unstable thoracic aortic aneurysm, iatrogenic or infective pseudoaneurysms, aortic fistula, acute aortic thrombus/occlusive disease, and vasculitis. Imaging plays a pivotal role in the patient’s management and care. In the emergency room, chest X-ray is the initial imaging test offering a screening evaluation for alternative common differential diagnoses and a preliminary assessment of the mediastinal dimensions. State-of-the-art multidetector computed tomography angiography (CTA) provides a widely available, rapid, replicable, noninvasive diagnostic imaging with sensitivity approaching 100%. It is an impressive tool in decision-making process with a deep impact on treatment including endovascular or open surgical or conservative treatment. Radiologists must be familiar with the spectrum of these entities to help triage patients appropriately and efficiently. Understanding the imaging findings and proper measurement techniques allow the radiologist to suggest the most appropriate next management step.

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“…For the ascending aorta, Thoracic endovascular aortic repair (TEVAR) is not yet in general use. Nevertheless, endovascular repair of PAU in the ascending aorta is used for high‐risk patients who are currently unsuitable for open repair …”

Section: Commentmentioning

confidence: 99%

Acute penetrating atherosclerotic ulcer of the ascending aorta

et al. 2019

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A 67‐year‐old man presented with chest pain. Clinical examination revealed hypertension (160/90 mm Hg). Electrocardiogram indicated no acute coronary syndrome and cardiac enzymes were normal. Catheterization was performed owing to the patient’s continuing chest pain and ascending aortogram revealed irregular aortic wall. A computed tomography image showed the shape of penetrating ulcer. The patient was taken to the operating room and intraoperative examination confirmed the diagnosis of penetrating atherosclerotic ulcer (PAU). Coronary artery bypass graft and bovine pericardial patch repair of PAU was performed. A bovine pericardial patch was done as aortic root was heavily calcified and was easy to handle and more hemostatic.

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Penetrating atherosclerosis aortic ulcer: a re-appraisal

Abstract: Penetrating aortic ulcer represents 2-7% of all acute aortic syndromes. Symptomatic penetrating aortic ulcer requires coverage by thoracic endovascular stent grafting according to the recent guidelines.

Cited by 6 publications

References 26 publications

Unibody design for aortic disease with a narrow aortic bifurcation: tips and tricks for success

Unibody design for aortic disease with a narrow aortic bifurcation: tips and tricks for success

MDCT Imaging of Non-Traumatic Thoracic Aortic Emergencies and Its Impact on Diagnosis and Management—A Reappraisal

Acute penetrating atherosclerotic ulcer of the ascending aorta

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