Endovascular stent-graft treatment of penetrating aortic ulcer: results over a median follow-up of 27 months

Penetrating ulcers of the thoracic aorta: results from a single-centre experience

OBJECTIVES

To report our mid-term results of stent-graft (SG) placement for the treatment of penetrating thoracic aortic ulcers.

METHODS

In the last 30 months, 11 patients (9 men; mean age 73 years; range 55 to 81) were treated for 12 penetrating thoracic aortic ulcers using SGs. Five patients were symptomatic: 2 had ruptured ulcers and 2 cases were complicated with dissection. Mean European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 10. Three patients had concomitant endovascular repair for an infrarenal abdominal aortic aneurysm (AAA). Follow-up included periodic computed tomography angiography (CT-A) scans at 1, 4, and 12 months after the intervention, and yearly thereafter.

RESULTS

Primary technical success was achieved in 100% of patients; no conversion was required. In-hospital mortality did not occur. Paraplegia was not observed. Mean follow-up was 15 months (range 2 to 36). One patient died of respiratory failure 2 months after the intervention. Radiologic follow-up did not detect endoleaks. Survival was 90% at 1 and 3 years.

CONCLUSIONS

Our experience confirms the feasibility of SG treatment for elective and urgent repair of penetrating aortic ulcers. Our current attitude is to treat all the ulcers of the descending aorta using an endovascular technique, since SG treatment represents a good treatment option, as the morbidity and mortality are low.

Malignant Fibrous Histiocytoma Arising From the Aortic Wall Mimicking a Pseudoaneurysm With Ulceration

Malignant fibrous histiocytoma of the thoracic aorta associated with ulcer-like projection has not been reported previously. The hypovascular tumor of the thoracic aorta involved the mural layer, which showed intra- and extra-mural growth patterns and no significant filling defect within the aortic lumen, and mimicked ulcer-like projection with secondary pseudoaneurysm formation. Aortic tumor, although rare, should be included among the causes of an ulcer-like projection.