Endovascular stent-graft treatment of penetrating aortic ulcer

Eggebrecht, Holger MD
Herold, Ulf MD
Schmermund, Axel MD
Lind, Alexander Y. MD
Kuhnt, Oliver MD
Martini, Stefan MD
Kühl, Hilmar MD
Kienbaum, Peter MD
Peters, Jürgen MD
Jakob, Heinz MD
Erbel, Raimund MD
Baumgart, Dietrich MD

^aDepartment of Cardiology, West-German Heart Center Essen, University of Duisburg-Essen, Essen, Germany
^bDepartment of Cardio-thoracic Surgery, West-German Heart Center Essen, University of Duisburg-Essen, Essen, Germany
^cDepartment of Diagnostic and Interventional Radiology, West-German Heart Center Essen, University of Duisburg-Essen, Essen, Germany
^dDepartment of Anesthesiology and Intensive Care Medicine, West-German Heart Center Essen, University of Duisburg-Essen, Essen, Germany

Reprint requests: Holger Eggebrecht, MD, Department of Cardiology, University of Duisburg-Essen, Hufelandstraße 55, 45122 Essen, Germany. E-mail: [email protected]

This study was supported by a research grant from the University Duisburg-Essen, Essen, Germany (IFORES 10+2) (Dr Eggebrecht).

Submitted March 18, 2005; accepted May 9, 2005

American Heart Journal 151(2):p 530-536, February 2006.

Background

Penetrating aortic ulcer (PAU) is increasingly acknowledged as a pathological variant of classic false-lumen aortic dissection with a high incidence of bleeding complications and rupture in up to 40% of patients. The objective of this study was to investigate the results of endovascular stent-graft placement for the treatment of patients with PAUs.

Methods

Between July 1999 and December 2004, endovascular stent-graft repair of PAU was performed in 22 patients (69.1 ± 7.8 years, 16 men), 3 (14%) of whom had contained aortic rupture. Stent-graft placement was performed in the cardiac catheterization laboratory with the patient under general anesthesia, using a surgical access.

Results

Procedural success was achieved in all but 1 patient (technical success rate 96%). Postoperatively, 1 (5%) patient had minor stroke with transient amentia. There were no other inhospital complications or deaths. During a median follow-up of 27 (range 1–62) months, 1 patient underwent adjunctive stent-graft placement for type I endoleak. Three patients died unrelated to the aortic disease late during follow-up. Overall survival rates were 100% at 30 days, 100% at 1 year, 82.5% ± 11.3% at 2 years, and 61.9% ± 20.0% at 5 years.

Conclusions

Endovascular stent-graft treatment is an effective treatment for patients with PAU and is associated with low procedural morbidity. Both acute and midterm mortality of this novel treatment concept appear to be favorable compared with the natural course of the disease.