Long-Term Imaging Evolution and Clinical Prognosis Among Patients With Acute Penetrating Aortic Ulcers: A Retrospective Observational Study

Abstract

Background Acute penetrating aortic ulcers (PAUs) are reported to dynamically evolve into different clinical outcomes ranging from regression to aortic rupture, but no practice guidelines are available in China. Methods and Results All 109 patients with acute PAUs were monitored clinically. At 30 days follow-up, 31 patients (28.44%) suffered from aortic-related adverse events, a composite of aortic-related mortality, aortic dissection, or an enlarged ulcer. In addition, 7 (6.42%) patients had clinically related adverse events, including all-cause mortality, cerebral stroke, nonfatal myocardial infarction, acute heart failure alone or acute exacerbation of chronic heart failure, acute renal failure, arrhythmia, and bleeding events. In the present study, the intervention criteria for the Chinese PAU population included a PAU diameter of 12.5 mm and depth of 9.5 mm. The multivariate analysis showed that an ulcer diameter >12.5 mm (hazard ratio [HR], 3.846; 95% CI, 1.561-9.476; P=0.003) and an ulcer depth >9.5 mm (HR, 3.359; 95% CI, 1.505-7.494; P=0.003) were each independent predictors of aortic-related events. Conclusions Patients with acute PAUs were at high risk for aortic-related adverse events and clinically related adverse events within 30 days after onset. Patients with an ulcer diameter >12.5 mm or an ulcer depth >9.5 mm have a higher risk for disease progression, and early intervention may be recommended.

Keywords: acute aortic syndrome; aortic‐related adverse events; endovascular repair; penetrating aortic ulcer.

Figure 1. Acute penetrating aortic ulcer: flow chart of research target.

EVAR indicates endovascular repair; and PAU, penetrating aortic ulcer.

Figure 2. Survival curve of the clinical outcomes of all patients during follow‐up.

The data show that 7 adverse clinical events occurred within 30 days.

Figure 3. Receiver operating characteristic curve analysis for prediction of penetrating aortic ulcer based on the ulcer diameter and depth.

AUC indicates area under the curve.

Figure 4. An unadjusted Kaplan–Meier curve stratified by in‐hospital and follow‐up complications.

Figure 5. Typical morphological multidetector computed tomography imaging data.

A, C, and E, During the acute phase, a computed tomographic angiography scan demonstrates the presence of a penetrating aortic ulcer and a periaortic hematoma. B, The ulcer is enlarged. D, Computed tomographic angiography scan shows that the ulcer is stable and that the periaortic hematoma has almost completely disappeared. F, Computed tomographic angiography scan reveals a typical dissection.