title: Endovascular therapy for penetrating ulcers of the infrarenal aorta.
abstract: BACKGROUND
  We sought to investigate the short- and mid-term results of the endovascular repair of infrarenal abdominal penetrating aortic ulcers (aPAUs).
  
  
  METHODS
  Patients with infrarenal aPAUs treated by endovascular means between March 2004 and June 2012 were recruited. Pre-interventional imaging included computed tomography (CT) or CT angiography. Endoprostheses were chosen and deployed according to standard elective endovascular aneurysm repair anatomical requirements. Endpoints included 30-day survival, in-hospital mortality, 1-year PAU-related mortality, 1-year all-cause mortality, freedom from death and freedom from cumulative complication and interventions. Statistically, the Kaplan-Meier method was applied.
  
  
  RESULTS
  Nineteen patients (18 men, median age 70 years (interquartile range, IQR = 59-75)) suffering aPAUs (n = 29, infrarenal = 25) were detected. The median co-morbid severity scoring was 1.0 (IQR = 0.4-1.4). The median follow-up period was 33 months (IQR = 8-51.5). Furthermore, 94.7% of patients had hypertension. Fourteen patients (73.7%) had symptoms, including four of them admitted with shock from large-contained PAU rupture. Endoluminal stent grafting was successfully delivered in all patients. In-hospital mortality was 10.5%. Two patients required secondary interventions (10.5%). The 30-day survival, 1-year PAU-related mortality and 1-year all-cause mortality were 94.7%, 89.5% and 89.5%, respectively. Freedom from death and freedom from cumulative complications and interventions was 86.4% and 86.4%, 78.9% and 78.9%, and 67.9% and 71.2% at 12, 24 and 36 months, respectively.
  
  
  CONCLUSIONS
  Urgent and elective endovascular repair of aPAUs can be achieved with high technical success. The significant co-morbid status of the treated patients is illustrated in the considerable in-hospital mortality and underlines the advantage of such treatment over open surgical repair.
authors: Department of Vascular Surgery, 'Demokritus' University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.
authors: George S
authors: GS
authors: Georgiadis
authors: George
authors: G
authors: Trellopoulos
authors: George A
authors: GA
authors: Antoniou
authors: Efstratios I
authors: EI
authors: Georgakarakos
authors: Evagelos S
authors: ES
authors: Nikolopoulos
authors: Dimitrios
authors: D
authors: Pelekas
authors: Xanthi
authors: X
authors: Pitta
authors: Miltos K
authors: MK
authors: Lazarides
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D050197:Atherosclerosis / Q000150:complications*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014456:Ulcer / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*
keywords: abdominal aorta; endovascular therapy; penetrating aortic ulcer