[Penetrating atherosclerotic ulcer of the aortic arch].
Acute aortic syndrome is an acute lesion of the aortic wall involving the aortic tunica media, with a potencial risk of severe complications. The aortic dissection is the main cause (80%), but other entities, such as the intramural hematoma (15%) and the penetrating aortic ulcer (5%), are a less frequent cause. A 49-year-old man, hypertensive, dyslipemic, and without drug treatment, was admitted in the emergency service due to a sudden pain in the mid-chest approximately 3 hr previously. No pain radiation or hemodynamic affectation were apparent. The symptoms were resistant to nitroglycerin and morphine. The chest X rays, electrocardiograms and cardiac enzymes were normal. A computed tomographic angiography was taken because an acute aortic symdrome was suspected (figure 1A). It showed a sacular formation compatible with an aortic ulcer in the left contour of the aortic arch, and situated one-half cm beyond the left subclavian artery and above a zone of parietal calcification. The acute symtomatic penetrating aortic ulcer syndrome carries an equal or greater risk than the typical dissection; therefore invasive treatment was recommended. Because of the potential risk of severe complications and unpredictable prognosis, a self-expanding endoluminal prosthesis (stent graft), Relay 30 x 100 mm, was implanted for femoral artery access with satisfactory results (figure 1B and 1C).
Gómez
Rubén
R
Servicio de Cardiología, Hospital de Laredo, Laredo, Cantabria, España. rgi@ozu.es
Fleitas
Cristina
C
Teja
Carlos
C
Carrascosa
Miguel
M
Arrastio
Xavier
X
Celemín
Isabel
I
D001013:Aorta, Thoracic / Q000473:pathology*; D001018:Aortic Diseases / Q000175:diagnosis / Q000473:pathology*; D019917:Blood Vessel Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D014057:Tomography, X-Ray Computed; D017540:Tunica Media / Q000473:pathology; D014456:Ulcer / Q000175:diagnosis / Q000473:pathology*