Thoracic Endovascular Aortic Repair for Penetrating Aortic Ulcer: Literature Review

Abstract

Background: The aim of the study was to provide a literature review of thoracic endovascular aortic repair (TEVAR) outcomes for penetrating ulcer of the aorta.

Methods: Relevant articles in the Embase, Medline, and Cochrane databases reporting the results of endovascular repair for penetrating ulcers of the thoracic aorta were systematically searched and reviewed.

Results: Thirty-one articles were integrated after a literature review, and 310 patients treated by TEVAR for penetrating ulcers of the aorta were identified. In this cohort, most patients were male (65.8%), had a history of smoking (60.4%), and systemic hypertension (90%). Only 9% were asymptomatic at initial presentation. Most cases (76%) occurred among patients with a single ulcer, located in the descending thoracic aorta (81%), with associated intramural hematoma in 45%. The technical success of TEVAR was 98.3%. Surgical conversion during the postoperative period with stent-graft explantation was required in 1 patient. The overall 30-day mortality was 4.8% (15 of 310). The most frequent complications were endoleaks (8%, 25 of 310) and access problems (16.1%, 26 of 161). After a mean follow-up of 17.7 months (range, 1 to 52), the all-cause mortality was 22.9% (71 of 310), and the aortic-related mortality was 4.1% (13 of 310). During follow-up, new endoleak and ulcer recurrence were observed in 5.4% (n = 15 of 274) and 4.5% (n = 5 of 110), respectively, requiring a new aortic endovascular procedure in 50% (n = 10).

Conclusions: Thoracic endovascular aortic repair of penetrating ulcer has excellent short-term and midterms results. The endovascular approach should be the first line management for aortic ulcer when intervention is indicated.