Mid and Long-term Results of Endovascular Treatment of Thoracic Penetrating Aortic Ulcers

Abstract

Introduction and objectives:

Thoracic penetrating aortic ulcers are an infrequent, but potentially serious entity, and its treatment is still controversial. This study presents the long-term results of the endovascular treatment for penetrating ulcers of the thoracic aorta.

Methods:

Between 1998 and 2023, 42 patients diagnosed with thoracic penetrating aortic ulcers were treated with endografts at a tertiary care hospital. Preoperative, intraoperative, and follow-up complications and mortality data were collected and analyzed. Survival rates during follow-up were estimated using Kaplan-Meier curves.

Results:

Treatment was indicated for symptomatic cases in 14 patients (33.3%), most of whom presented with thoracic or dorsal pain, 1 with distal embolization, and 2 with aortic rupture. Standard thoracic endografts were used in 38 cases (90%), while branched/scalloped and/or fenestrated endografts were employed in 4 cases, with an average of 1.2 endografts per patient. Eight cases (19%) required prior revascularization of supra-aortic trunks. Technical success was 100%, with no intraoperative deaths or open conversions. In-hospital medical complications occurred in 16.6% of patients, and the 30-day cumulative mortality rate was 4.7%. After a mean follow-up of 71.7 months (range: 0.1–283 months), the endoleak rate was 19% and the cumulative 5-year reintervention-free survival rate was 80.6%. The overall survival rates at 1, 5, and 10 years were 87.4%, 77.5%, and 60.5%, respectively.

Conclusions:

Endovascular treatment for penetrating ulcers of the thoracic aorta demonstrates favorable short and long-term outcomes, with high technical success and low aorta/procedure related mortality.

Clinical Impact

This study reinforces TEVAR as a safe and effective first-line therapy for penetrating aortic ulcers, offering clinicians strong long-term data to support decision-making in a high-risk, elderly population. The findings underscore that most PAUs can be treated with limited aortic coverage and minimal adjunctive procedures, reducing procedural complexity and morbidity. The extended follow-up—among the longest reported—highlights durable aortic exclusion, while emphasizing the importance of lifelong imaging due to endoleak-related reinterventions.

Keywords

penetrating atherosclerotic ulcer endovascular procedures acute aortic syndrome endovascular aneurysm repair aorta thoracic

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