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. 2022 Apr;38(Suppl 1):198-203.
doi: 10.1007/s12055-022-01332-3. Epub 2022 Mar 9.

Management of penetrating aortic ulcer and intramural hematoma in the thoracic aorta

David L Warner  1 , Castigliano M Bhamidipati  2 , Cherrie Z Abraham  3
Affiliations

Management of penetrating aortic ulcer and intramural hematoma in the thoracic aorta

David L Warner et al. Indian J Thorac Cardiovasc Surg. 2022 Apr.

Abstract

Acute aortic syndrome is a broad clinical entity that encompasses several pathologies. Aortic dissection is a well-studied disorder, but the other most prominent disorders within the scope of acute aortic syndrome, penetrating aortic ulcer and intramural hematoma, are more nebulous in terms of their pathophysiology and treatment strategies. While patient risk factors, presenting symptoms, and medical and surgical management strategies are similar to those of aortic dissection, there are indeed nuanced differences unique to penetrating aortic ulcer and intramural hematoma that surgeons and acute care providers must consider while managing patients with these diagnoses. The aim of this review is to summarize patient demographics, pathophysiology, workup, and treatment strategies that are unique to penetrating aortic ulcer and intramural hematoma.

Keywords: Acute aortic syndrome; Intramural hematoma; Penetrating aortic ulcer.

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Conflict of interest statement

Drs. Warner and Bhamidipadi have no conflicts of interest pertinent to this manuscript. Dr. Abraham is a paid consultant for the Medtronic Aortic Advisory Board, a paid consultant as an Advanced Aortic Intervention proctor, and a paid consultant for WL Gore as a Clinical Events Committee member for the Gore Conformable Stent Graft Clinical Trial.

Figures

Fig. 1
Fig. 1
Sagittal section of a CT angiogram of the chest demonstrating penetrating aortic ulcer in segment 3 of the aorta, denoted by asterisk
Fig. 2
Fig. 2
Axial section of a CT angiogram of the chest demonstrating intramural hematoma, indicated by stars, at the level of T7 (a). Sagittal section of the same study (b)
Fig. 3
Fig. 3
Sagittal section of a CT angiogram of the chest demonstrating penetrating aortic ulcer (asterisk) at the level of T8 with associated intramural hematoma (star)
See this image and copyright information in PMC

References

    1. Corvera JS. Acute aortic syndrome. Ann Cardiothorac Surg. 2016;5:188–193. - PMC - PubMed
    1. Evangelista A, Maldonado G, Moral S, et al. Intramural hematoma and penetrating ulcer in the descending aorta: differences and similarities. Ann Cardiothorac Surg. 2019;8:456–470. - PMC - PubMed
    1. Korepta LM, Aulivola B. Aortic intramural hematomas and penetrating aortic ulcerations: indications for treatment versus surveillance. Endovascular Today. 2020;19:78–82.
    1. Lansman SL, Saunders PC, Malekan R, Spielvogel D. Acute aortic syndrome. J Thorac Cardiovasc Surg. 2010;140:S92–S97. - PubMed
    1. Stanson AW, Kazmier FJ, Hollier LH, et al. Penetrating atherosclerotic ulcers of the thoracic aorta: natural history and clinicopathologic correlations. Ann Vasc Surg. 1986;1:15–23. - PubMed

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