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Endovascular repair of symptomatic penetrating atherosclerotic ulcer of the thoracic aorta

CT Marketing Philips Healthcare

Pauls S, Orend KH, Sunder-Plassmann L, Kick J, Schelzig H.

Department of Diagnostic and Interventional Radiology, University of Ulm, Germany.


* Originally published in the July 2007 issue edition of the European Journal of Vascular and Endovascular Surgery: The official journal of the European Society for Vascular Surgery


In this study we evaluate published and personal experience of Endovascular Repair (EVAR) of penetrating atherosclerotic ulcers (PAU).


Patients and Methods
In 12 patients (mean 74 years, 58-87 years) PAU was diagnosed with computer tomography (CT). Symptomatic ulcers were treated by vascular surgeons using stent grafts via a femoral access route. Patients were followed up clinically and with CT for an average of 849 days (186-1968 days).


11 patients had severe acute thoracic pain, one patient presented with hemoptysis. CT showed well outlined ulcer, intramural hematoma, and contrast enhancement of the aortic wall (n=12), pseudoaneurysm (n=11), intimal calcification adjoining the ulcer (n=10), pleural (n=9) and mediastinal fluid (n=4). Mean duration of surgery was 68min (32-120 min). Primary technical success was achieved in all patients. There was no perioperative complications except one acute hemorrhage from an intercostal artery and one iliac dissection. Three months after stent graft application owing to a severe stenosis of the right common femoral artery, an iliofemoral bypass was performed in one patient. All patients were free of symptoms after the procedure. There was incomplete sealing of PAU in two of 12 patients, but no re-intervention was needed. All patients were alive during follow-up.


Symptomatic PAU is a potentially fatal lesion. Considering the low morbidity and mortality of EVAR, this option might be first choice.

For more information about this publication, check out the PubMed listing for this article.

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Aug 25, 2008

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abdomen, aorta, atherosclerosis, Body, calcification, follow up, pseudoanyeursm, Thorax

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