Penetrating atherosclerosis aortic ulcer: a re-appraisal

Acta Chir Belg. 2017 Feb;117(1):1-7. doi: 10.1080/00015458.2016.1212566. Epub 2016 Sep 3.


Background: Penetrating aortic ulcer is a rare pathology, often clinically silent, but potentially fatal when manifesting as an acute aortic syndrome. It is more often detected in recent years, due to ageing of the population and more widespread use of computed tomography. A literature review aims to define the distinct disease entity of penetrating aortic ulcer.

Methods: Five recent cases of penetrating aortic ulcer, treated in authors' department are reported. A review of English-language medical literature from 1980 to 2015 was undertaken using PubMed and EMBASE databases, to identify studies reporting surgical (open and endovascular) treatment of penetrating aortic ulcer.

Results: From September 2013 to September 2015, five cases of acute aortic syndrome caused by a penetrating atherosclerotic ulcer of the descending thoracic aorta were observed in authors' department. This represents 9% of all acute aortic syndromes admitted to our hospital in the same period. All five patients benefitted from thoracic endovascular stent grafting with a 100% success rate. Natural history and optimal management of penetrating aortic ulcer are outlined according to the most recent insights.

Conclusion: Penetrating aortic ulcer represents 2-7% of all acute aortic syndromes. Symptomatic penetrating aortic ulcer requires coverage by thoracic endovascular stent grafting according to the recent guidelines.

Keywords: Penetrating aortic ulcer; TEVAR; aortic dissection; intramural hematoma; stent graft; thoracic aorta.

Publication types

  • Review

MeSH terms

  • Aortic Diseases / diagnostic imaging*
  • Aortic Diseases / therapy*
  • Atherosclerosis / diagnostic imaging*
  • Atherosclerosis / therapy*
  • Humans
  • Ulcer / diagnostic imaging*
  • Ulcer / therapy*