Endovascular repair of abdominal infrarenal penetrating aortic ulcers: a prospective observational study.

OBJECTIVE: Penetrating atherosclerotic ulcer generally occurs in elderly patients with systemic atherosclerosis, predominantly in the descending thoracic aorta, and it is uncommon in the infrarenal aorta. We reviewed our experience of endovascular treatment of penetrating aortic ulcer in the infrarenal aorta. METHODS: In the last 4 years, out of 348 patients who underwent abdominal aortic procedures, a total of 13 patients (12 men and 1 woman) were found to have an abdominal penetrating aortic ulcer, corresponding to an incidence of 3.7%. Mean age was 73+/-7 years. All patients had hypertension. Three lesions were discovered incidentally and 10 were symptomatic. All patients underwent endovascular treatment in the operating room. Follow-up included CT-A control at 1, 4 and 12 months after the intervention, and yearly thereafter. RESULTS: Primary technical success was 100%. No postoperative death was observed. Mean operative time was 100+/-29 min. Mean blood loss was 168+/-133 ml. No patient required intensive care unit stay. We observed one major complication (transient ischemic attack). Mean hospital stay was 4+/-1 days. During a mean follow-up period of 26 months no endoleak, aneurysm evolution or stent graft failure was recognized in any patient. One patient died 24 months after the intervention after a stroke. CONCLUSIONS: In our experience, endovascular or repair of infrarenal aortic ulcer appears feasible, and midterm results satisfactory.