Penetrating ulcers of the thoracic aorta: results from a single-centre experience

Piffaretti, Gabriele; Tozzi, Matteo; Lomazzi, Chiara; Rivolta, Nicola; Riva, Francesca; Maida, Simona; Caronno, Roberto; Laganà, Domenico; Carrafiello, Giampaolo; Cuffari, Salvatore; Castelli, Patrizio

doi:10.1016/j.amjsurg.2006.08.073

« Previous Next »The American Journal of Surgery
Volume 193, Issue 4 , Pages 443-447, April 2007

Penetrating ulcers of the thoracic aorta: results from a single-centre experience

Gabriele Piffaretti, M.D.
- Vascular Surgery-Department of Surgery, University of Insubria, Varese, Italy
- Corresponding author. Vascular Surgery-University of Insubria, Ospedale di Circolo, 21100 viale Borri, 57 Varese, Italy. Tel.: +39332278226; fax: +39332278581.
Matteo Tozzi, M.D.
- Vascular Surgery-Department of Surgery, University of Insubria, Varese, Italy
Chiara Lomazzi, M.D.
- Vascular Surgery-Department of Surgery, University of Insubria, Varese, Italy
Nicola Rivolta, M.D.
- Vascular Surgery-Department of Surgery, University of Insubria, Varese, Italy
Francesca Riva, M.D.
- Vascular Surgery-Department of Surgery, University of Insubria, Varese, Italy
Simona Maida, M.D.
- Vascular Surgery-Department of Surgery, University of Insubria, Varese, Italy
Roberto Caronno, M.D.
- Vascular Surgery-Department of Surgery, University of Insubria, Varese, Italy
Domenico Laganà, M.D.
- Institute of Radiology, University of Insubria, Varese, Italy
Giampaolo Carrafiello, M.D.
- Institute of Radiology, University of Insubria, Varese, Italy
Salvatore Cuffari, M.D.
- Anesthesia and Palliative Care, University of Insubria, Varese, Italy
Patrizio Castelli, M.D., F.A.C.S.
- Anesthesia and Palliative Care, University of Insubria, Varese, Italy

Received 19 May 2006; received in revised form 2 August 2006

Abstract

Objectives

To report our mid-term results of stent-graft (SG) placement for the treatment of penetrating thoracic aortic ulcers.

Methods

In the last 30 months, 11 patients (9 men; mean age 73 years; range 55 to 81) were treated for 12 penetrating thoracic aortic ulcers using SGs. Five patients were symptomatic: 2 had ruptured ulcers and 2 cases were complicated with dissection. Mean European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 10. Three patients had concomitant endovascular repair for an infrarenal abdominal aortic aneurysm (AAA). Follow-up included periodic computed tomography angiography (CT-A) scans at 1, 4, and 12 months after the intervention, and yearly thereafter.

Results

Primary technical success was achieved in 100% of patients; no conversion was required. In-hospital mortality did not occur. Paraplegia was not observed. Mean follow-up was 15 months (range 2 to 36). One patient died of respiratory failure 2 months after the intervention. Radiologic follow-up did not detect endoleaks. Survival was 90% at 1 and 3 years.

Conclusions

Our experience confirms the feasibility of SG treatment for elective and urgent repair of penetrating aortic ulcers. Our current attitude is to treat all the ulcers of the descending aorta using an endovascular technique, since SG treatment represents a good treatment option, as the morbidity and mortality are low.

Keywords: Penetrating thoracic aortic ulcers, Stent-graft, Endovascular