title: Early and midterm results after endovascular stent graft repair of penetrating aortic ulcers.
abstract: OBJECTIVE
  To present early and midterm results after endovascular stent graft repair of patients with penetrating aortic ulcers (PAU).
  
  
  METHODS
  Between January 1997 and March 2008, a total of 202 patients received thoracic aortic endografting in our institution, 48 patients (32 men, median age 70 years, range, 48-89) with PAU. A retrospective analysis of these patients was performed. Thirty-one patients (65%) showed an acute aortic syndrome (8 contained rupture, 23 symptomatic). Follow-up scheme included postoperative computed tomography angiography prior to discharge, at 3, 6, and 12 months, and yearly thereafter. Mean follow-up was 31.3 months (1.3-112.6).
  
  
  RESULTS
  Technical success was achieved in 93.7%. Primary clinical success rate was 81.2%. In-hospital mortality was 14.6%. Perioperative mortality was significantly (P = .036) higher in patients with acute aortic syndrome compared to asymptomatic patients (22.5% vs 0%). Postoperative complications occurred in 15 patients (31%), including 2 patients with minor strokes and 6, respectively, 5 patients with cardiac and/or respiratory complications. Early endoleaks were observed in 9 patients (19%), late endoleaks in another 2 patients. Reintervention was necessary in 4 out of 48 patients (8.4%). The actuarial survival estimates at 1, 3, and 5 years were 78% +/- 6%, 74% +/- 7%, and 61% +/- 10%, respectively. There was no aortic-related death during follow-up. Cox regression showed age (hazard ratio [HR]; 1.08, P = .036) and a maximum aortic diameter >50 mm (HR, 4.92; P = .021) as independent predictors of death.
  
  
  CONCLUSIONS
  Endovascular treatment of penetrating aortic ulcers is associated with a relevant morbidity and mortality rate in frequently highly comorbid patients. Midterm results could prove a sustained treatment success regarding actuarial survival and aortic-related death. Emergencies show a significantly worse outcome, but treatment is still warranted in these symptomatic patients.
authors.affiliation: Department of Vascular and Endovascular Surgery, Ruprecht-Karls University, Heidelberg, Germany. Philipp.Geisbuesch@med.uni-heidelberg.de
authors.forename: Philipp
authors.initials: P
authors.lastname: Geisbüsch
authors.forename: Drosos
authors.initials: D
authors.lastname: Kotelis
authors.forename: Tim F
authors.initials: TF
authors.lastname: Weber
authors.forename: Alexander
authors.initials: A
authors.lastname: Hyhlik-Dürr
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Kauczor
authors.forename: Dittmar
authors.initials: D
authors.lastname: Böckler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017546:Angioscopy / Q000379:methods*; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000175:diagnosis / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014456:Ulcer / Q000175:diagnosis / Q000601:surgery*