Abstract
Penetrating aortic ulceration (PAU) is part of the spectrum of acute aortic syndromes (AAS), and is defined as an ulcerated intimal disruption due to atherosclerotic disease. PAU may be simple, isolated and asymptomatic, or it may be symptomatic, aneurysmal and extensive; these may progress and lead to rupture. This review aims to evaluate the treatment options for PAU. Treatment options range from radiological surveillance, risk factor modification, best medical therapy and open or endovascular surgical repair. Patients with PAU are frequently older and comorbid with relatively damaged aortic tissue; this can make open surgical repair more challenging. Endovascular repairs for larger, symptomatic, aneurysmal PAU may be performed with acceptable outcomes. Complex endovascular repairs may be required depending on the pathology. Patients with small, asymptomatic, uncomplicated PAU may be safely followed up with surveillance. PAU with concomitant intramural haematoma (IMH) should be closely monitored to observe for resolution or progression following conservative and medical management strategies. PAU is a unique entity and its natural history should be studied independently to better understand appropriate management strategies. This research is currently lacking, and larger studies or registries may be helpful in optimising PAU management.
Highlights
Penetrating aortic/atherosclerotic ulceration (PAU) is defined as an ulcerated, intimal disruption due to atherosclerotic disease [1]
PAU fits into a spectrum of acute aortic syndromes (AAS) consisting of classical dissection, intramural haematoma (IMH), limited dissection and iatrogenic/traumatic transection (Figure 2) [3]
PAU may be located in the ascending aorta (Type A PAU), in the descending thoracic aorta
Summary
Penetrating aortic/atherosclerotic ulceration (PAU) is defined as an ulcerated, intimal disruption due to atherosclerotic disease [1]. It is radiologically distinct from other AAS, such as aortic dissection (AD) [2]. Symptomatic, extensive, aneurysmal PAU is thought to have an increased risk of rupture; the exact rupture risk is unclear, it has been estimated that approximately 14%–40% of patients present or go on to rupture [9,12,13,14]. PAU may be located in the ascending aorta (Type A PAU), in the descending thoracic aorta (Type B PAU) or abdominal aorta Symptomatic, extensive, aneurysmal PAU is thought to aorticthe syndromes (AAS), from dissection, intramural. It is hypothesised that continued erosion of the aortic wall in PAU may lead to disruption
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
