[Penetrating aortic ulcer: a series of 15 cases with thoracic and thoraco-abdominal management].
Penetrating aortic ulcer (PAU) consists of an ulcer located in the aortic wall that can cause sudden-onset thoracic or thoraco-abdominal pain. Symptomatic PAU is a life-threatening emergency because of the high risk of aortic rupture. First described in 1934, PAU was for many years seen only at autopsy. Now, multislice CT is the diagnostic method of choice. We report the cases of 15 such patients. Ten patients were symptomatic, with severe sudden-onset thoracic or thoraco-abdominal pain (7 cases) or less acute pain (3 cases). Surgical treatment consisted of aortic stent-grafting in 13 cases, with one or more endoprostheses. Bypass surgery was also necessary in 6 cases, using a hybrid technique (ilio-hepatic bypass graft in 1 case, multiple visceral bypass grafts in 3 cases, carotid-carotid bypass graft in 1 case, and carotid left subclavian bypass graft in 1 case), or a combined technique (aneurysmectomy and infrarenal Dacron tube repair in 1 case). Open thoraco-abdominal aortic repair was performed in two cases, with proximal anastomosis at the thoracoabdominal level and distal anastomosis at the level of the aortic carre four (with the Crawford inclusion technique in one case). Perioperative results were satisfactory, but one patient died of multiple organ failure on postoperative day 14. Four patients died during follow-up (mean 16.2 months ; range 1-44 months), 1 of stroke, 1 of a complicated esophageal-aortic fistula, and 2 of unknown causes. Follow-up has been uneventful in the other 10 patients.
Palombo
Domenico
D
Chirurgie vasculaire et endovasculaire, CHU San Martino, largo R. Benzi 10, 16132, Genova, Italie. domenico.palombo@unige.it
Mambrini
Simone
S
D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014456:Ulcer / Q000175:diagnosis / Q000628:therapy