Penetrating atherosclerotic aortic ulcers

Thoracic painful syndrome: Penetrating atherosclerotic aortic ulcers repres ent a condition in which an atherosclerotic plaque ulcerates and disrupts t he internal elastic lamina, allowing intramural hematoma formation into the aortic media. Recently individualized as an entity from ail vascular thora cic painful syndroms, they affect preponderantly the elderly patients with a medical hypertensive and atherosclerotic history and with multiple cardio vascular risk factors. The descending thoracic aorta is most frequently inv olved. Imaging: Computed tomography scanning and magnetic resonance imaging tend t o replace aortography in providing an accurate diagnosis of the ulceration and of its parietal extent. Moreover, they allow the discrimination with ao rtic dissection or with intramural hematoma without intimal rupture which o utcome and treatment should differ. Risks: In the absence of complication, progressive aneurysmal dilatation at the level of the ulcer is a rule. Pseudoaneurysm formation, embolization, and acute transmural aortic rupture can however occur and may justify, in s elected cases, a preventive or curative surgical treatment. Stent-grafting: Endovascular stent grafting techniques may appear as a safe and effective less invasive choice in highrisk patients with suitable anat omical conditions.