Penetrating atherosclerotic ulcer of the descending thoracic aorta: treatment by endovascular stent-graft.
OBJECTIVE
To present four cases of penetrating ulcer of the descending thoracic aorta treated by transfemoral insertion of an endoluminal stent-graft.


METHODS
Four patients with penetrating aortic ulcers were reviewed. Three cases were complicated by rupture, false aneurysm, or retrograde dissection. All patients were treated by endovascular stent-graft and were followed by helical computed tomography (CT).


RESULTS
Endovascular stent-graft deployment was successful in all patients. However, in one case we observed a perigraft leak that spontaneously disappeared within the first month, and two interventions were needed for another patient. Following treatment, one episode of transient spinal ischemia was observed. The 30-day survival rate was 100%, but one patient died from pneumonia with cardiac failure 34 days after the procedure. In one patient, helical CT performed at 3 months showed a false aneurysm independent of the first ulcer. This patient refused any further treatment and suddenly died at home (unknown cause) after a 6-month follow-up period.


CONCLUSIONS
Transluminal placement of endovascular stent-grafts for treatment of penetrating ulcers of the descending thoracic aorta appears to be a possible alternative to classical surgery. After treatment, follow-up by CT is essential to detect possible complications of the disease.
Murgo
S
S
Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Belgium.
Dussaussois
L
L
Golzarian
J
J
Cavenaile
J C
JC
Abada
H T
HT
Ferreira
J
J
Struyven
J
J
D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001027:Aortography; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D002406:Catheterization, Peripheral; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008297:Male; D015607:Stents; D016896:Treatment Outcome