Long‐Term Imaging Evolution and Clinical Prognosis Among Patients With Acute Penetrating Aortic Ulcers: A Retrospective Observational Study

Abstract

Background Acute penetrating aortic ulcers (PAUs) are reported to dynamically evolve into different clinical outcomes ranging from regression to aortic rupture, but no practice guidelines are available in China. Methods and Results All 109 patients with acute PAUs were monitored clinically. At 30 days follow‐up, 31 patients (28.44%) suffered from aortic‐related adverse events, a composite of aortic‐related mortality, aortic dissection, or an enlarged ulcer. In addition, 7 (6.42%) patients had clinically related adverse events, including all‐cause mortality, cerebral stroke, nonfatal myocardial infarction, acute heart failure alone or acute exacerbation of chronic heart failure, acute renal failure, arrhythmia, and bleeding events. In the present study, the intervention criteria for the Chinese PAU population included a PAU diameter of 12.5 mm and depth of 9.5 mm. The multivariate analysis showed that an ulcer diameter >12.5 mm (hazard ratio [HR], 3.846; 95% CI, 1.561–9.476; P =0.003) and an ulcer depth >9.5 mm (HR, 3.359; 95% CI, 1.505–7.494; P =0.003) were each independent predictors of aortic‐related events. Conclusions Patients with acute PAUs were at high risk for aortic‐related adverse events and clinically related adverse events within 30 days after onset. Patients with an ulcer diameter >12.5 mm or an ulcer depth >9.5 mm have a higher risk for disease progression, and early intervention may be recommended.

Endovascular treatment of penetrating atherosclerotic ulcers of the arch and thoracic aorta: In-hospital and 5-year outcomes

“…Like in other series, 15 , 16 , 17 , 18 in-hospital mortality after endovascular repair is approximately 4% to 15% and results of TEVAR in PAU patients compare favorably with TEVAR for other indications, with a high rate of technical success (98%-100%), few neurologic complications (0-5%), and few requirements for reinterventions (0-20%). In our experience postoperative angiographic CT revealed early endoleaks in approximately 16% of the population but most were type IV and none of them required intervention.…”

“…They concluded that size-related criteria might not be helpful in predicting PAU behavior. In a more recent study, Yang and colleagues 15 reported long-term imaging evolution and prognosis in 109 PAUs and showed that patients with an ulcer diameter >12.5 mm (HR, 3.8; P = .003) or an ulcer depth >9.5 mm (HR, 3.4; P = .003) have a higher risk for disease progression. According to Chou and colleagues, 16 between medically managed patients with PAU the lesion rarely resolved and persisted or worsened in 85% of cases, with 30% requiring late operation.…”

Clinical and Imaging Predictors of Disease Progression in Type B Aortic Intramural Hematomas and Penetrating Aortic Ulcers: A Systematic Review

“…Of these, 17 studies were included in the present review, all observational and retrospective ( Figure 1 ). Two studies only reported on PAUs [ 11 , 14 ], two studies reported on PAUs and IMHs [ 5 , 10 ] and thirteen articles only concentrated on IMHs [ 12 , 13 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ].…”

“…Overall, of 237 patients with PAUs, in 193 the disease was localized in the descending thoracic and abdominal aorta (type B) (81%); two studies also included PAUs located in the aortic arch [ 11 , 14 ]. In 218 cases (92%), authors analyzed PAUs with an acute onset.…”

“…All articles on PAUs reported ulcer location, number, depth, width, neck width and maximum aortic diameter (MAD). Two authors also described the presence and thickness of periaortic hematoma [ 10 , 11 ].…”