Penetrating Atherosclerotic Ulcers of the Infrarenal Aorta: Life-threatening Lesions

Abstract

Review of the literature and this series suggests that PAU of the abdominal aorta is a life-threatening lesion, the main risk being rupture. Surgical management is recommended owing to its low morbidity and mortality.

Abdominal Aortic Disease Caused by Penetrating Atherosclerotic Ulcers

“…Batt et al and Tsuji et al stated that an ulcerative lesion not extending beyond the aortic wall on angiograms or CT images should be added to the definition of PAU. 2,16) Therefore, saccular aneurysm, aortic rupture, and isolated abdominal aortic dissection are complications due to the progression of PAU. Isolated dissection was observed in 1 of our 4 patients and a saccular aneurysm in 3 patients, of whom 2 developed aortic rupture.…”

“…Therefore, compared with fusiform aneurysms, the risks of migration and endoleak as complications specific to stent grafting decrease. 2,8,11,16,17,21,24) In the future, stent grafting as well as surgery will be a treatment choice based on the patient's general condition and preoperative activity.…”

“…In particular, in the abdominal aorta, aneurysm formation is considered to occur more readily than dissection. 2,10) Differentiation among these complications, as well as PAU, is often difficult, and there is a mixture of various pathological conditions. Batt et al and Tsuji et al stated that an ulcerative lesion not extending beyond the aortic wall on angiograms or CT images should be added to the definition of PAU.…”

“…When there is no cardiogenic thrombosis source, the necessity of suspecting the presence of PAU as a cause of embolism has also been suggested. 2,30) Concerning treatment methods, anatomical vascular reconstruction using vascular grafts, are generally performed. In recent years, stent grafts have been introduced, and treatment experiences with them for PAU and saccular aneurysms have been reported.…”

Analysis of Early and Distant Results Following Endovascular Repair of the Descending and Abdominal Aorta

“…Data analyses evaluated the place of endovascular operations in the treatment of rupturing, ruptured and inflammatory abdominal aortic aneurysms (16,17,18). Recently, stentgrafts are being implanted in case of penetrating aortic ulcers (19,20). In Poland, the first report concerning the implantation of a bifurcated stentgraft into the abdominal aorta was published in 1999 (21).…”