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Hearts—A New International Open Access Journal for Cardiology, Cardiac and Vascular Surgery

The Management of Penetrating Aortic Ulcer

Department of Surgery and Cancer, St. Mary’s Hospital, Imperial Vascular Unit, Imperial College London, London W2 1NY, UK
University Hospital Southampton, NHS Foundation Trust, Southampton SO16 6YD, UK
Author to whom correspondence should be addressed.
Hearts 2020, 1(1), 5-13;
Received: 23 April 2020 / Revised: 14 May 2020 / Accepted: 14 May 2020 / Published: 15 May 2020
(This article belongs to the Special Issue Thoracic Aorta)
Penetrating aortic ulceration (PAU) is part of the spectrum of acute aortic syndromes (AAS), and is defined as an ulcerated intimal disruption due to atherosclerotic disease. PAU may be simple, isolated and asymptomatic, or it may be symptomatic, aneurysmal and extensive; these may progress and lead to rupture. This review aims to evaluate the treatment options for PAU. Treatment options range from radiological surveillance, risk factor modification, best medical therapy and open or endovascular surgical repair. Patients with PAU are frequently older and comorbid with relatively damaged aortic tissue; this can make open surgical repair more challenging. Endovascular repairs for larger, symptomatic, aneurysmal PAU may be performed with acceptable outcomes. Complex endovascular repairs may be required depending on the pathology. Patients with small, asymptomatic, uncomplicated PAU may be safely followed up with surveillance. PAU with concomitant intramural haematoma (IMH) should be closely monitored to observe for resolution or progression following conservative and medical management strategies. PAU is a unique entity and its natural history should be studied independently to better understand appropriate management strategies. This research is currently lacking, and larger studies or registries may be helpful in optimising PAU management. View Full-Text
Keywords: aortic disease; aorta; thoracic; acute aortic syndromes; penetrating aortic ulcer; penetrating atherosclerotic ulcer aortic disease; aorta; thoracic; acute aortic syndromes; penetrating aortic ulcer; penetrating atherosclerotic ulcer
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MDPI and ACS Style

Salim, S.; Machin, M.; Patterson, B.O.; Bicknell, C. The Management of Penetrating Aortic Ulcer. Hearts 2020, 1, 5-13.

AMA Style

Salim S, Machin M, Patterson BO, Bicknell C. The Management of Penetrating Aortic Ulcer. Hearts. 2020; 1(1):5-13.

Chicago/Turabian Style

Salim, Safa; Machin, Matthew; Patterson, Benjamin O.; Bicknell, Colin. 2020. "The Management of Penetrating Aortic Ulcer" Hearts 1, no. 1: 5-13.

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