Early and midterm results after endovascular stent graft repair of penetrating aortic ulcers

Abstract

Endovascular treatment of penetrating aortic ulcers is associated with a relevant morbidity and mortality rate in frequently highly comorbid patients. Midterm results could prove a sustained treatment success regarding actuarial survival and aortic-related death. Emergencies show a significantly worse outcome, but treatment is still warranted in these symptomatic patients.

Endovascular repair of the ascending aorta: the last frontier?

“…The distal landing zone can be extended, if there is need for overstenting of the brachiocephalic trunk or even the left carotid artery, by bypassing from the left carotid to the right carotid artery, or even from the left subclavian to the right carotid artery, as in one case with a traumatic rupture of the brachiocephalic trunk that we treated (Figure 1). Obviously, focal lesions, such as ulcers and pseudoaneurysms, as presented in this paper are better to treat comparing to aneurysms or dissections, yet even these procedures carry a relevant morbidity and mortality risk, as seen previously (10,11).…”

Endovascular Repair of Thoracic Aortic Emergencies

“…The signs of disease progression include aortic diameter ≥40 mm and thickening of the aortic wall ≥10mm. Close surveillance in these patients is critical (Geisbüsch et al, 2008). The prevalence of penetrating aortic ulcer among patients presenting with acute aortic syndrome is about 2%-8%.…”

“…The rupture rate in symptomatic penetrating aortic ulcer is reported to be as high as 40% compared to 4% in Stanford type B dissection. Therefore, urgent repair is required in symptomatic cases (Geisbüsch et al, 2008;Tittle et al, 2002;Coady et al, 1996;Ganaha et al, 2002). Signs of progression of this condition include aortic ulcer diameter >20 mm and ulcer depth >10 mm.…”

“…Early mortality after TEVAR in penetrating aortic ulcer is reported at 0%-11%. Mediumterm outcomes have been published, with 1-, 3-, and 5-year survival rates of 85%, 75%, and 60%, respectively (Geisbüsch et al, 2008;Botta et al, 2008;Demers et al, 2004).…”

Akutes Aortensyndrom

“…Zunächst wenig beachtet, wird zunehmend die Bedeutung des penetrierenden Aortenulkus (PAU) erkannt [19,20] [26,27,28,29]. Dazu gehörten auch akute Aortenerkrankungen.…”