Isolated Ruptured Paravisceral Penetrating Aortic Ulcers

• Published in: Annals of vascular surgery Vol. 81; pp. 138 - 147
• Main Authors: Omran, Safwan, Raude, Ben, Schawe, Larissa, Carstens, Jan Christoph, Angermair, Stefan, Berger, Christian, Konietschke, Frank, Treskatsch, Sascha, Greiner, Andreas
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2022
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2021.09.042

•Isolated ruptured paravisceral penetrating aortic ulcers (PV-PAUs) are rare and life-threatening conditions.•This study reports a single-center experience on patients with isolated ruptured PV-PAUs and provides information on treatment and outcome to guide therapy and decision-making.•Treatment options include Open aortic repair, hybrid procedures and parallel stent-graft techniques. The goal of this study is to investigate the clinical presentation, treatment options, and outcomes of the patients with isolated ruptured paravisceral penetrating aortic ulcers (PV-PAU). All patients presenting with acute aortic syndrome from 2015 to 2020 were screened, of which patients with isolated ruptured PV-PAU were included in this retrospective study. Study endpoints were the assessment of treatment options, technical success, and clinical outcome. Outcome measures included major perioperative complications and mortality. Sixteen patients (11 men; median age 68; IQR 60 – 75 years) presented with isolated ruptured PV-PAU were included in this study. The median follow-up was 25 months (range 1 – 51). Ruptured PV-PAUs represented 12.3% of the ruptured aortic aneurysms in all locations. PV-PAUs were found in segment A (n = 8, 50%), segment B (n = 5, 31%), and segment C (n = 3, 19%). PV-PAUs showed a mean protrusion distance of 27±10 mm, a mean neck diameter of 21 ± 7 mm, and maximal aortic diameter of 50 ± 11 mm. Five patients (31%) showed hemodynamic instability on admission and needed intense fluid resuscitation. Of those, 2 patients needed urgent laparotomy with a fast transabdominal supraceliac aortic clamping, one needed an aortic balloon occlusion to obtain rapid aortic control. The open aortic repair was the most frequently performed surgery (11/16, 69%), followed by hybrid procedures (3/16) and parallel graft chimney technique (2/16). Two patients died during the follow-up, calculating for in-hospital and 1-year mortality rates of 6 – 12%, respectively. The postoperative morbidity rate was 31%. Postoperative complications included acute renal failure (31%), pneumonia (25%), and 1case of ischemic colitis (6%). No spinal cord ischemia was reported. Ruptured PV-PAU is a rare and challenging diagnostic and therapeutic entity. Open aortic repair seems to be a reliable option in treating patients with isolated ruptured PV-PAUs. Hybrid procedures and parallel stent-graft techniques can only be used in selected patients.