Endovascular treatment of penetrating aortic ulcers: mid-term follow-up.
OBJECTIVE
The aim of this work is to describe the short- and mid-term results of endovascular treatment of penetrating ulcers in the thoracic aorta.


METHODS
Between 1998 and 2010, 22 patients with penetrating ulcers in the thoracic aorta received endografts (mean age 69.8 years, 91% male); 50% were indicated for acute aortic syndrome (8 chest pain, 1 aortic rupture, 1 aortobronchial fistula, 1 distal embolization) and 50% for aortic or ulcer diameter. All preoperative, operative and follow-up data were recorded prospectively and met EUROSTAR criteria.


RESULTS
Technical success was 100% with no intraoperative deaths or open conversions; 6 (27.3%) required preoperative supraaortic trunk debranching and 1.3 endografts were used per patient; 27.3% developed complications in-hospital and 9.1% required reintervention prior to discharge. Mortality at 30 days was 4.5%. After a mean 52.3 month follow-up (range 0.1-122), cumulative survival free from complications and reinterventions at 100 months was 61.7% and 79.5% respectively, with 95.5% cumulative survival free from aorta- or procedure-related death. We identified no factors significantly related to poor intra- or postoperative clinical course.


CONCLUSIONS
Endovascular treatment of penetrating aortic ulcers is both possible and effective despite high patient comorbidity. Although a substantial rate of complications and reinterventions can be expected-especially in-hospital-(38.3% and 20.5% respectively at 100 months), long-term mortality is low (4.5%).
Sección de Cirugía Vascular, Servicio de Cirugía Cardiovascular, Instituto Clínico del Tórax, Hospital Clínic, Universidad de Barcelona, Barcelona, España. gasparmestres@gmail.com
Gaspar
G
Mestres
Rubén
R
Rodríguez
Cesar
C
García-Madrid
Xavier
X
Montañà
Marta
M
Burrel
Luis Fernando
LF
Cruz
Carlos
C
Flores
Vicente
V
Riambau
D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D000792:Angiography; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery; D001018:Aortic Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014456:Ulcer / Q000401:mortality / Q000473:pathology / Q000601:surgery*