Acute Aortic Syndrome/Rupture of Penetrating Aortic Ulcer

Author: John Hermsen, MD; Edward Verrier, MD
Institution: University of Washington
Date Reviewed: July 2014
Learning Domain: Adult Cardiac Surgery
Learning Objective: Penetrating Aortic Ulcer, Great Vessel Disease
PowerPoint File: Acute Aortic Syndrome/Rupture of Penetrating Aortic Ulcer

 

Discussion Points for Conference

  • Natural History of Penetrating Ulcer / Intramural Hematoma
    • Risk of Rupture
  • Timing / Indications  for surgery
    • Elective vs Urgent vs Emergent
  • Surgical Approaches
    • TEVAR
    • Open
  • Complications
    • Stroke
    • Paraplegia
    • Endoleak
  • Expected outcomes
  • Follow up planning

 

Learning Points

  • Penetrating Ulcers can be chronic or acute
  • Atherosclerosis as etiology
  • Usually in heavy smokers
  • Endografting emerging as therapeutic option of choice
  • Prognosis may be worse than dissection
  • 20% symptomatic, 50% complicated, 4% rupture acutely