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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2006 June;13(2):87-93
Endovascular and surgical repair for penetrating ulcers of the abdominal aorta
Sensi L., Pisano E., Magnoni F., Pilato A., Pedrini L.
Operative Unit of Vascular Surgery Maggiore Hospital of Bologna, Italy
Aim. Penetrating atherosclerotic ulcers (PAU) are ulcerations of atherosclerotic plaques penetrating through the intima, more frequent in elderly people, uncommon in the infrarenal aorta, that may lead to intramural hematoma, aneurysm formation, aortic dissection or rupture. The aim of this study was to analyze the incidence, clinical features, and treatment of PAU of the abdominal aorta, the effectiveness of endovascular stent graft treatment and to identify risk factors for treatment failure.
Methods. From 2001 to 2005, 11 patients with PAU of the abdominal aorta have been treated: 10 were male and 1 female, with a mean age of 76.7 years. One treated for ruptured abdominal aortic aneurysm (AAA), 2 with contained hematoma. Five patients underwent open surgery, and 6 an endovascular repair (EVAR) under spinal anesthesia.
Results. Endograft positioning was technically successful in all the patients without conversion and type I endoleak. The patient treated for ruptured AAA died. At 22.8±15.7 months follow-up, the other patients are alive without graft complication after open surgery. In the EVAR group, 1 patient presented a 2nd type endoleak with reduction of the aortic diameter, but with the PAU excluded. A diameter reduction has been recorded in 2 patientsa and a complete shrinkage in 4.
Conclusions. PAU of the abdominal aorta are observed generally after complication or symptoms; their diagnosis is difficult because often the aortic diameter is normal. The risk of rupture is now recognized and confirmed by our experience; the indication to treatment is accepted. As infrarenal aortic, PAU are generally localized, and an endovascular grafting appears to be a feasible alternative to surgical repair in many cases.