title: Endovascular repair of infrarenal penetrating aortic ulcers: a single-center experience in 20 patients.
abstract: OBJECTIVE
  To present the early and midterm results of endovascular stent-graft repair in patients with infrarenal penetrating aortic ulcers (PAU).
  
  
  METHODS
  Between January 1997 and December 2009, 20 patients (17 men; median age 72 years, range 48-85) with PAU of the infrarenal aorta underwent endovascular repair. In this cohort, 2 (10%) patients had a concomitant PAU in the descending thoracic aorta. Indications for treatment were aortic rupture in 2 patients, persistent or recurrent pain in 3 patients, and progression of PAU size or morphological aspects (e.g., thin wall) in the 15 asymptomatic patients. Follow-up included serial aortic imaging at predefined intervals.
  
  
  RESULTS
  The technical success rate was 100%. In-hospital mortality was 10%, with 2 patients dying of myocardial infarction (MI). Postoperative complications were observed in 5 of 20 patients (4 MIs, 1 case of pneumonia, 1 acute on chronic renal failure, and a lymphatic complication at the access site). Primary endoleaks were observed in 4 (20%) patients and a secondary endoleak in 1 patient. The median follow-up was 22.3 months (range 0.4-104). The actuarial survival estimates at 1, 3, and 5 years were 77%, 69%, and 69%, respectively, with no aorta-related death during follow-up. The reintervention rate during follow-up was 10%, including 1 conversion at 11 months for type III endoleak.
  
  
  CONCLUSIONS
  Patients with PAU have a significant number of cardiovascular comorbidities. The endovascular repair of infrarenal penetrating aortic ulcers thus is accompanied by mortality and morbidity caused predominantly by cardiac complications.
authors.affiliation: Department of Vascular and Endovascular Surgery, Ruprecht-Karls University Heidelberg, Germany. Alexander.duerr@med.uni-heidelberg.de
authors.forename: Alexander
authors.initials: A
authors.lastname: Hyhlik-Dürr
authors.forename: Philipp
authors.initials: P
authors.lastname: Geisbüsch
authors.forename: Drosos
authors.initials: D
authors.lastname: Kotelis
authors.forename: Dittmar
authors.initials: D
authors.lastname: Böckler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation; D015607:Stents; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014456:Ulcer / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*