Abdominal aortic intramural hematoma related to penetrating ulcer: an inappropriate indication for endovascular repair?
OBJECTIVE
To present a rare case of abdominal aortic intramural hematoma with penetrating ulcer.


METHODS
A 68-year-old hypertensive lady was admitted with chest pain. An echo Doppler abdominal study showed a 2.5-cm-diameter abdominal aorta with periaortic blood flow. Urgent computed tomography documented a 4-cm aneurysmal dilatation, 4 cm long, at the infrarenal level of the inferior mesenteric artery origin, which appeared on the angiogram as a very short lateral bleb. At elective open laparotomy, no true abdominal atherosclerotic aneurysm was found in the retroperitoneal space, but rather, an intramural hematoma with ulcer. An aortobi-iliac graft was inserted, and the patient was discharged with a good outcome. Histological examination of the explanted tissue confirmed adventitial calcifications, organized thrombus in the hematoma, and intimal neovascularization.


CONCLUSIONS
Considering the pathology, this case was more appropriately treated with open surgery, although endovascular repair was not excluded as an option.
Ventura
Marco
M
Department of Vascular Surgery, University of L'Aquila, Italy. marco.ventura4@tin.it
Mastromarino
Alessandro
A
Cucciolillo
Lucia
L
Calvisi
Giuseppe
G
Spartera
Carlo
C
D000368:Aged; D000800:Angioplasty, Balloon; D001012:Aorta, Abdominal / Q000601:surgery; D001018:Aortic Diseases / Q000150:complications* / Q000601:surgery*; D005260:Female; D006406:Hematoma / Q000150:complications* / Q000601:surgery*; D006801:Humans; D014456:Ulcer / Q000150:complications* / Q000601:surgery*