Endovascular Repair of Infrarenal Penetrating Aortic Ulcers: A Single-Center Experience in 20 Patients

Abstract

To present the early and midterm results of endovascular stent-graft repair in patients with infrarenal penetrating aortic ulcers (PAU). 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. 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. 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.