Penetrating ulceration of the infrarenal aorta: Case reports of an embolicand an asymptomatic lesion

Penetrating aortic ulceration is uncommon in the infrarenal aorta. We descr ibe a patient with a penetrating infrarenal aortic ulcer manifesting as blu e toe syndrome, and a second patient with a similar lesion identified as an incidental finding. These two patients were treated for penetrating infrar enal; aortic ulceration within the past 9 months at two university-affiliat e hospitals, a regional Veterans Administration Medical Center, and a Count y Medical Center. Both lesions demonstrated aneurysm changes with varying d egrees of mural thrombus. The lesion filled with fresh thrombus proved labi le, with embolization manifesting as blue toe syndrome. We support the aggr essive treatment of aneurysmal penetrating aortic ulcer with aortic graft r eplacement to eliminate the potential for distal embolization and to obviat e the risk of rupture and death.