Endovascular stent-graft repair for penetrating atherosclerotic ulcer in the infrarenal abdominal aorta

Abstract

Infrarenal aortic lesions caused by PAU were generally localized, and endovascular grafting appears to be a feasible alternative to surgical repair.

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.…”

“…Tsuji et al described the necessity of complete evaluation of the aorta once PAU was detected. 16) Multi-detector CT, recently developed, may be particularly useful for diagnosis because extensive, detailed information on the aorta can be straightforwardly obtained. In addition, MRI has been reported to be helpful in diagnosis because the signal intensity of the aortic wall increases in the presence of PAU on both T1-and T2-weighted images.…”

“…In addition, MRI has been reported to be helpful in diagnosis because the signal intensity of the aortic wall increases in the presence of PAU on both T1-and T2-weighted images. 16,19) The natural history of PAU is still unclear, and opinions are also divided concerning the timing of treatment. Emergency operation is naturally necessary in patients showing persistent abdominal symptoms, a rapid increase in PAU, or unstable hemodynamics.…”

“…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.…”

Double Tube Stent-Grafts for Infrarenal Aortic Aneurysm: A New Concept

“…Penetrating aortic ulcers are seldom in the infrarenal aorta but could be treated with either single or double tube grafts. [10][11][12] The shaggy aorta described by Hollier et al 13 is also an indication for either single or double tube grafts. 13 High-risk patients, especially, could benefit from this easier and shorter procedure given suitable anatomy because local and regional anesthesia are easily applied with this technique.…”