Management of penetrating aortic ulcer

CT: computed tomography; IMH: intramural hematoma; MR: magnetic resonance; PAU: penetrating aortic ulcer.

* Symptoms may include severe or persistent pain, or evidence of distal embolization (atheroembolism, thromboembolism).

¶ High-risk features include maximum PAU diameter ≥13 to 20 mm, maximum PAU depth ≥10 mm, significant expansion of PAU diameter or depth, PAU associated with a saccular aneurysm, and PAU with an increasing pleural effusion^[1].

Δ Anti-impulse therapy aims to reduce aortic shear stress and minimize lesion progression by reducing blood pressure and heart rate, typically initially using intravenous beta blockers.

◊ The urgency of repair depends on the clinical presentation; emergency repair is required for ruptured or symptomatic PAU.

§ For repair of a PAU in the distal aortic arch (zones 2-3), descending thoracic aorta (zones 4,5), or abdominal aorta (zones 6,7,8,9), either open surgical repair or endovascular repair is reasonable, based on anatomy and medical comorbidities.