Surgical or Endovascular Therapy of Abdominal Penetrating Aortic Ulcers and Their Natural History: A Systematic Review

Georgiadis, George S.; Antoniou, George Α.; Georgakarakos, Efstratios; Nikolopoulos, Evagelos S.; Παπάνας, Νικόλαος; Trellopoulos, George; Iatrou, Christos; Papadopoulou, Maria Z; Lazarides, Miltos K.

doi:10.1016/j.jvir.2013.05.067

Cited by 22 publications

(16 citation statements)

References 64 publications

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“…Patients demonstrating progression or presenting with hemodynamic instability undergo surgical intervention either in the form of open surgery or endovascular repair with a stent graft unless deemed unfit to undergo an intervention. [9][10][11][12] The natural history of PAUs is poorly understood with limited literature 4 and there are no randomized controlled trials (RCTs) on the progression, management and follow-up of PAUs, specifically in asymptomatic patients. Current guidelines are based on observational studies and expert opinion.…”

Section: Introductionmentioning

confidence: 99%

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The Management of Patients With Penetrating Aortic Ulcers: A Systematic Review

Pandey

Sharma

2021

Vasc Endovascular Surg

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Background: Penetrating aortic ulcers (PAUs) are an entity within acute aortic syndrome. They often remain undiagnosed and are found incidentally or when they become symptomatic. Management is currently guided by clinical judgment. This review aims to identify indications for treatment and inform management. Methods: We searched PubMed for studies on the management of PAUs. The outcome measures were mortality, progression and resolution of symptoms. Results: This review incorporates 27 studies involving 1356 patients with PAU. Data was available regarding symptoms for 1213 patients (494 symptomatic, 719 asymptomatic). Overall late mortality for PAUs was found to be higher than 30-day mortality. Early mortality was higher for symptomatic patients as compared to those with asymptomatic PAUs. Early mortality was lowest for PAUs treated with endovascular interventions (5%), followed by PAUs managed medically and highest following open surgical management. Indications for treatment included symptoms, progression/instability, aortic diameter >5 cm, concomitant aortic pathology or pleural effusion. 13% of patients managed conservatively at initial presentation demonstrated progression and were considered for intervention subsequently. 9% of patients required reintervention after initial endovascular surgery. Conclusion: Endovascular treatment, if anatomically suitable, should be considered as first line treatment for symptomatic PAUs. Patients with asymptomatic PAUs, if associated with high-risk features such as PAU diameter >20 mm, PAU depth >10 mm, aortic diameter >42 mm, concomitant pathology, morphological change or an infective etiology, should also be considered for intervention. Small asymptomatic PAUs with no high-risk features may be managed conservatively but must undergo regular surveillance.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Management of Patients With Penetrating Aortic Ulcers: A Systematic Review

Pandey

Sharma

2021

Vasc Endovascular Surg

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“…Although the indications for surgery of abdominal aorta PAU are not well established, symptomatic disease is the main indication for surgery due to elevated risk of rupture (20-50%). 1,17,18 After surgery, the patients remained free from symptoms or complications during the follow-up period. (Figure 4).…”

Section: Penetrating Aortic Ulcer (Pau)mentioning

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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“…However, in patients with asymptomatic PAU, it appears that conservative treatment is more appropriate, because there are not yet well-defined criteria that justify interventional treatment, whether for the thoracic or for the abdominal segments. 43,45 Among these patients, the extent of penetration into the tunica media and the size of the neck of the injury are of questionable value as criteria for indicating surgery, as was demonstrated in the largest clinical series in the literature. 43 In asymptomatic patients, indications for open or endovascular surgery are restricted to cases with evidence of pseudoaneurysm formation.…”

Section: Natural Historymentioning

confidence: 99%

Hematoma intramural e úlcera penetrante da aorta: incertezas e controvérsias

Pereira

2019

J. vasc. bras.

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Resumo A história natural do hematoma intramural (HI) e da úlcera penetrante (UP) é muito variável, já que podem progredir para a formação de aneurisma, ruptura, dissecção, e podem até mesmo regredir, no caso específico do HI. Exames de imagem têm crescente papel no manejo clínico e operatório da UP e do HI. Ao contrário das projeções semelhantes a úlcera, achados de lagos sanguíneos não são relatados nos estudos tomográficos de pacientes com HI. O entendimento das características da imagem e do curso natural de cada uma dessas entidades ajudará clínicos e cirurgiões a identificar os pacientes com maior risco para um mau prognóstico e pode melhorar os desfechos. A fisiopatologia dessas entidades, as controvérsias no que se refere a suas histórias naturais e os fatores prognósticos das imagens tomográficas são discutidos neste artigo.

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Surgical or Endovascular Therapy of Abdominal Penetrating Aortic Ulcers and Their Natural History: A Systematic Review

Cited by 22 publications

References 64 publications

The Management of Patients With Penetrating Aortic Ulcers: A Systematic Review

The Management of Patients With Penetrating Aortic Ulcers: A Systematic Review

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

Hematoma intramural e úlcera penetrante da aorta: incertezas e controvérsias

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