Thoracic Endovascular Aortic Repair for Penetrating Aortic Ulcer: Literature Review

Abstract

Thoracic endovascular aortic repair of penetrating ulcer has excellent short-term and midterms results. The endovascular approach should be the first line management for aortic ulcer when intervention is indicated.

Surgical debranching for endovascular arch penetrating ulcer management

“…Sealing in zone 0 (ascending aorta), as was necessary in the present case due to a short proximal landing zone, confronts the clinician with other technical challenges (4,5). When choosing a debranching strategy with the proximal anastomosis in the ascending aorta, several options remain; the first is to perform the proximal anastomosis using a side-biting clamp, with its inherent risk of iatrogenic type-A dissection, which may be reduced by performing this anastomosis in an (partially) unloaded beating heart situation as described.…”

Arch and access vessel complications in penetrating aortic ulcer managed with thoracic endovascular aortic repair

“…From an anatomical point of view, the extent of the involved aorta is much less in PAU than aneurysmal disease and the lesion itself is also often short in length (6,11). These anatomical features may be, for example, favorable by limiting an important complication such as SCI occurrence but do impact on other threatening complications especially when located in the aortic arch (2,7,28). For example, the risk of stroke in patients with PAUs has been reported to be similar for TEVAR and open surgery (4% vs. 7%, respectively) (1).…”

“…Ann Cardiothorac Surg 2019;8(4):471-482 | http://dx.doi.org/10.21037/acs.2019.06.07 endovascular aortic repair (TEVAR) (2,3). Most PAUs are seen in the setting of diffuse and dense atherosclerotic disease, possibly including severe peripheral occlusive disease (4)(5)(6).…”

Single-stage Endovascular Treatment of a Penetrating Aortic Ulcer with a Concomitant “Isolated” Iliac Aneurysm

“…As type B PAUs are frequently localized, open surgical repair shows excellent results [3,8] and is considered the gold standard treatment. However, endovascular repair offers a less invasive approach in high-risk patients, showing good perioperative results with low 30-day mortality (4.8-7%) [10].…”

“…In summary, a symptomatic PAU associated with an asymptomatic IIA are synchronous aortoiliac lesions associated with a high risk of rupture of either lesion but can be treated in a single-stage manner using an endovascular approach. Despite lack of endoleak, continued surveillance is important, although the frequency of surveillance is not well established [10,13]. In addition, patients with IIA frequently develop multiple aneurysms, suggesting that surveillance and screening remains a life-long concern.…”