PENETRATING ATHEROSCLEROTIC ULCER OF THE DESCENDING THORACIC AORTA - TREATMENT BY ENDOVASCULAR STENT-GRAFT

Purpose: To present four cases of penetrating ulcer of the descending thoracic aorta treated by transfemoral insertion of an endoluminal ste nt-graft. Methods: Four patients with penetrating aortic ulcers were r eviewed. Three cases were complicated by rupture, false aneurysm, or r etrograde dissection. All patients were treated by endovascular stent- graft and were followed by helical computed tomography (CT). Results: Endovascular stent-graft deployment was successful in all patients. Ho wever, in one case we observed a perigraft leak that spontaneously dis appeared within the first month, and two interventions were needed for another patient. Following treatment, one episode of transient spinal ischemia was observed. The 30-day survival rate was 100%, but one pat ient died from pneumonia with cardiac failure 34 days after the proced ure. In one patient, helical CT performed at 3 months showed a false a neurysm independent of the first ulcer. This patient refused any furth er treatment and suddenly died at home (unknown cause) after a 6-month follow-up period. Conclusion: Transluminal placement of endovascular stent-grafts for treatment of penetrating ulcers of the descending tho racic aorta appears to be a possible alternative to classical surgery. After treatment, follow-up by CT is essential to detect possible comp lications of the disease.