G. S. Georgiadis MD; G. Trellopoulos MD; G. A. Antoniou MD; E. I. Georgakarakos MD; E. S. Nikolopoulos MD; D. Pelekas MD; X. Pitta MD; M. K. Lazarides MD, EBSQvasc.
Endovascular therapy for penetrating ulcers of the infrarenal aorta
Article first published online: 21 JAN 2013
© 2013 The Authors. ANZ Journal of Surgery © 2013 Royal Australasian College of Surgeons
ANZ Journal of Surgery
Volume 83, Issue 10, pages 758–763, October 2013
How to Cite
Georgiadis, G. S., Trellopoulos, G., Antoniou, G. A., Georgakarakos, E. I., Nikolopoulos, E. S., Pelekas, D., Pitta, X. and Lazarides, M. K. (2013), Endovascular therapy for penetrating ulcers of the infrarenal aorta. ANZ Journal of Surgery, 83: 758–763. doi: 10.1111/ans.12074
- Issue published online: 6 OCT 2013
- Article first published online: 21 JAN 2013
- Manuscript Accepted: 11 DEC 2012
- abdominal aorta;
- endovascular therapy;
- penetrating aortic ulcer
We sought to investigate the short- and mid-term results of the endovascular repair of infrarenal abdominal penetrating aortic ulcers (aPAUs).
Patients with infrarenal aPAUs treated by endovascular means between March 2004 and June 2012 were recruited. Pre-interventional imaging included computed tomography (CT) or CT angiography. Endoprostheses were chosen and deployed according to standard elective endovascular aneurysm repair anatomical requirements. Endpoints included 30-day survival, in-hospital mortality, 1-year PAU-related mortality, 1-year all-cause mortality, freedom from death and freedom from cumulative complication and interventions. Statistically, the Kaplan–Meier method was applied.
Nineteen patients (18 men, median age 70 years (interquartile range, IQR = 59–75)) suffering aPAUs (n = 29, infrarenal = 25) were detected. The median co-morbid severity scoring was 1.0 (IQR = 0.4–1.4). The median follow-up period was 33 months (IQR = 8–51.5). Furthermore, 94.7% of patients had hypertension. Fourteen patients (73.7%) had symptoms, including four of them admitted with shock from large-contained PAU rupture. Endoluminal stent grafting was successfully delivered in all patients. In-hospital mortality was 10.5%. Two patients required secondary interventions (10.5%). The 30-day survival, 1-year PAU-related mortality and 1-year all-cause mortality were 94.7%, 89.5% and 89.5%, respectively. Freedom from death and freedom from cumulative complications and interventions was 86.4% and 86.4%, 78.9% and 78.9%, and 67.9% and 71.2% at 12, 24 and 36 months, respectively.
Urgent and elective endovascular repair of aPAUs can be achieved with high technical success. The significant co-morbid status of the treated patients is illustrated in the considerable in-hospital mortality and underlines the advantage of such treatment over open surgical repair.