Single-stage Endovascular Treatment of a Penetrating Aortic Ulcer with a Concomitant “Isolated” Iliac Aneurysm

Abstract

Penetrating aortic ulcer (PAU) is an acute aortic syndrome that can proceed to life-threatening aortic dissection or even aortic rupture. Isolated iliac aneurysms are relatively rare and often asymptomatic due to their deep pelvic location but are frequently associated with high mortality with rupture. We report a case of a 68-year-old man with a symptomatic penetrating ulcer in the descending aorta and an asymptomatic right iliac aneurysm involving the common and internal iliac arteries. The patient was successfully treated by endovascular repair in a single-stage manner using stent grafts in the descending aorta and right common iliac artery after coil embolization of the right internal iliac artery. Follow-up imaging showed complete resolution of the PAU and exclusion of the right iliac aneurysm without endoleak. Aggressive endovascular treatment for a symptomatic PAU with an asymptomatic isolated iliac aneurysm is feasible and allows complete treatment of vascular pathology at a single time.

Key Words

Penetrating aortic ulcer - Iliac aneurysm - Endovascular

• References

• 1 Stanson AW, Kazmier FJ, Hollier LH, Edwards WD, Pairolero PC, Sheedy PF. , et al. Penetrating atherosclerotic ulcers of the thoracic aorta: natural history and clinicopathologic correlations. Ann Vasc Surg 1986; 1: 15-23 . DOI: 10.1016/S0890-5096(06)60697-3
• 2 Lansman SL, Saunders PC, Malekan R, Spielvogel D. Acute aortic syndrome. J Thorac Cardiovas Surg 2010; 140: S92-S97 . DOI: 10.1016/j.jtcvs.2010.07.062
• 3 Tittle SL, Lynch RJ, Cole PE, Singh HS, Rizzo JA, Kopf GS. , et al. Midterm follow-up of penetrating ulcer and intramural hematoma of the aorta. J Thorac Cardiovas Surg 2002; 123: 1051-1059 . DOI: 10.1067/mtc.2002.121681
• 4 Hu H, Takano T, Guntani A, Onohara T, Furuyama T, Inoguchi H. , et al. Treatment of solitary iliac aneurysms: clinical review of 28 cases. Surg Today 2008; 38: 232-236 . DOI: 10.1007/s00595-007-3598-1
• 5 Sandhu RS, Pipinos II. Isolated iliac artery aneurysms. Semin Vasc Surg 2005; 18: 209-215 . DOI: 10.1053/j.semvascsurg.2005.09.007
• 6 Coady MA, Rizzo JA, Elefteriades JA. Pathologic variants of thoracic aortic dissections. Penetrating atherosclerotic ulcers and intramural hematomas. Cardiol Clin 1999; 17: 637-657 . DOI: 10.1016/S0733-8651(05)70106-5
• 7 Nathan DP, Boonn W, Lai E, Wang GJ, Desai N, Woo EY. , et al. Presentation, complications, and natural history of penetrating atherosclerotic ulcer disease. J Vasc Surg 2012; 55: 10-15 . DOI: 10.1016/j.jvs.2011.08.005
• 8 Chou AS, Ziganshin BA, Charilaou P, Tranquilli M, Rizzo JA, Elefteriades JA. Long-term behavior of aortic intramural hematomas and penetrating ulcers. J Thorac Cardiovas Surg 2016; 151: 361-373 . DOI: 10.1016/j.jtcvs.2015.09.012
• 9 Evangelista A, Czerny M, Nienaber C, Schepens M, Rousseau H, Cao P. , et al. Interdisciplinary expert consensus on management of type B intramural haematoma and penetrating aortic ulcer. Eur J Cardiothorac Surg 2015; 47: 209-217 . DOI: 10.1093/ejcts/ezu386
• 10 D’Annoville T, Ozdemir BA, Alric P, Marty-Ane CH, Canaud L. Thoracic endovascular aortic repair for penetrating aortic ulcer: literature review. Ann Thorac Surg 2016; 101: 2272-2278 . DOI: 10.1016/j.athoracsur.2015.12.036
• 11 Cambria RP, Brewster DC, Moncure AC, Steinberg FL, Abbott WM. Spontaneous aortic dissection in the presence of coexistent or previously repaired atherosclerotic aortic aneurysm. Ann Surg 1988; 208: 619-624 . PMID: 3190289
• 12 Chaer RA, Vasoncelos R, Marone LK, Al-Khoury G, Rhee RY, Cho JS. , et al. Synchronous and metachronous thoracic aneurysms in patients with abdominal aortic aneurysms. J Vasc Surg 2012; 56: 1261-1265 . DOI: 10.1016/j.jvs.2010.06.037
• 13 Patel NV, Long GW, Cheema ZF, Rimar K, Brown OW, Shanley CJ. Open vs. endovascular repair of isolated iliac artery aneurysms: a 12-year experience. J Vasc Surg 2009; 49: 1147-1153 . DOI: 10.1016/j.jvs.2008.11.101