Surgical treatment of penetrating atherosclerotic ulcer of the descending aorta.

INTRODUCTION: The term "penetrating atherosclerotic ulcer" (PAU) of the aorta describes the condition in which ulceration of an aortic atherosclerotic lesion penetrates the internal elastic lamina into media. PAU is a high-risk lesion due to its deleterious effects on the integrity of aortic wall, with potentially fatal outcome. CASE REPORT: A patient with intensive, sharp chest pain irradiating to the back but with no signs of myocardial ischemia on an electrocardiogram was referred to our hospital. Transthoracic echocardiography showed no pathological changes of the ascending aorta. However, multislice computed tomography (CT) showed an aortic ulcer with varying degree of the subadventitial hemorrhage in the region of the thoracic aorta at the level of Th 8-9. Due to imminent rupture of the penetrating aortic ulcer, the patient was promptly prepared for surgery. A 15 cm long subadventitial hematoma was found intraoperatively in the right posterolateral aspect of the descending aorta, 5 cm above the diaphragm and 7 cm below the origin of the left subclavial artery. The affected segment of the aorta was resected, followed by an inlay aortic reconstruction with a Dacron tube graft of 24 mm. Control CT revealed satisfactory reconstruction of the descending aorta. CONCLUSION: PAU is a rare, but potentially fatal disease. Open surgery in patients with PAU is an effective treatment strategy, although endovascular treatment options are emerging.

Thromboexclusion of the complete aorta in the treatment of chronic type B aneurysm.

We report a case of a 55-year-old woman who was referred to us with a huge chronic postdissection thoracoabdominal aneurysm of a maximal intrathoracic diameter of 13.5 cm and signs of intrathoracic imminent rupture with subparietal pleural hemorrhagic effusion. Computed tomography examination revealed that the left lung had undergone complete atelectasis and carnification owing to compression of the left principal bronchus. There were also signs of left kidney atrophy because of the left renal artery originating from the thrombosed false lumen. Owing to delicate preoperative condition, we decided to perform thromboexclusion of the complete aorta with reattachment of all the supra-aortic and visceral branches and complete bipolar exclusion of thoracoabdominal aorta. The patient was discharged from the hospital on the 35th postoperative day in a good condition. Following computed tomography scan revealed complete thrombosis of the excluded portion of the aorta.