Endovascular stent-graft repair for penetrating atherosclerotic ulcer in the infrarenal abdominal aorta.
OBJECTIVE
Penetrating atherosclerotic ulcer (PAU) is an ulceration of an atherosclerotic plaque penetrating through the intima, which may lead to intramural hematoma, aneurysm formation, or rupture. This disease is predominantly found in the thoracic aorta and is uncommon in the infrarenal aorta. The effectiveness of endovascular repair of PAU in the infrarenal aorta was retrospectively investigated.


METHODS
From 1999 to 2002, PAU was diagnosed with computed tomography and magnetic resonance imaging in the abdominal aorta in four patients. All patients were men; their average age was 78 years. All four patients had hypertension, and two patients had concomitant coronary artery disease. Three patients had abdominal pain or lumbago.


RESULTS
All patients underwent endovascular grafting with a Gianturco Z-stent covered with thin-wall woven Dacron graft. Indications for endovascular intervention were aneurysm formation with or without intramural hematoma in two patients and contained rupture with extraaortic hematoma in two patients. The postoperative course was uneventful in all cases, and no endoleak or aneurysm expansion was recognized during follow-up (4-32 months; average, 14 months).


CONCLUSIONS
Infrarenal aortic lesions caused by PAU were generally localized, and endovascular grafting appears to be a feasible alternative to surgical repair.
Tsuji
Yoshihiko
Y
Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
Tanaka
Yosuke
Y
Kitagawa
Atsushi
A
Hino
Yutaka
Y
Taniguchi
Takanori
T
Sugimoto
Koji
K
Matsuda
Hitoshi
H
Okita
Yutaka
Y
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000379:methods*; D001012:Aorta, Abdominal / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014456:Ulcer / Q000209:etiology / Q000601:surgery*